Characteristics and Needs of People With Intellectual Disability Who Have Higher IQs

Be a Fan. You see that on Special Olympics literature, websites, and paraphernalia. More than a mere slogan, Be a Fan is part of a belief system that values people with intellectual disability for their gifts and talents, their abilities and humanity. I am a Special Olympics volunteer. Like approximately 550,000 people in the United States and 850,000 internationally (Andrea Cahn, personal communication, October 14, 2010), I give a small bit of my time, talent, and treasure to Special Olympics as Senior Advisor to the Chairman and CEO. No, I am not out there coaching or training athletes or refereeing events, that is just not something where I have anything to offer. I am participating in discussions, reviewing or drafting the occasional document, and responding to ideas and issues impacting the inclusion and full citizenship of people with intellectual disability, something I have been doing for most of my adult life. I hope my very small contribution to Special Olympics is helping the movement towards the goals of full citizenship, community membership, and respect for all people with intellectual disability. Movements and organizations, like people, grow and change. I am writing this article because, as the world for people with intellectual and developmental disabilities continues to change and evolve, I think those who have advocated for community inclusion and participation have an ally, one we have failed to recognize, and with gifts and talents we have ignored, one we need to take seriously, and one who many of us shunned in the past. Special Olympics is a program we need now perhaps more than ever.

This article describes the use of in-house funding, private contracts, and a mixture of the two for applications in public transit operations. Three transit agencies are presented as examples: SunLine Transit (Thousand Palms, California), Foothill Transit (Los Angeles County), and Phoenix Public Transport (Phoenix, Arizona). Private contracts are often less expensive due to cost-savings measures on the part of the private entity. One such example involves paying employees less money on an hourly wage than is possible within a public organization. In addition, organizations avoid paying for outsourced Social Security, Medical, unemployment, and workers' compensation for these contracts. Lastly, private contracts cut down on slow bureaucratic processes that hinder public organization. However, using in-house employees has advantages such as greater control over quality of service. In the case of a combined public and private operation, the author notes that, due to the potential for maximized efficiency, cost per ride rates are among the lowest for peers. Likewise, the agency is afforded some of the control of public employees while gaining the efficiencies of private.

The Impact of COVID-19 on Individuals With Intellectual and Developmental Disabilities: Clinical and Scientific Priorities.

This is the third in a series of perspective articles (Schalock et al., 2007; Wehmeyer et al., 2008) from the Terminology and Classification Committee of the American Association on Intellectual and Developmental Disabilities (AAIDD). The purpose of these articles is to share our thoughts on critical issues associated with terminology, definition, and classification in the field of intellectual disability and to seek input from the field as we prepare the 11th edition of AAIDD's Diagnosis, Classification, and System of Supports Manual (the working title). In the first article (Schalock et al., 2007), we explained the reasons for shifting from the term mental retardation to intellectual disability. Although the two terms cover the same population of individuals, we concluded that intellectual disability was the better term because itIn the second article (Wehmeyer et al., 2008), we distinguished between operational and constitutive definitions of intellectual disability and discussed their application to understanding the construct underlying the term intellectual disability. The primary function of an operational definition is to assure consistency among diagnosticians by setting parameters for observing and recording evidence of the disability (Wehmeyer et al., 2008). We supported the continued use of the operational definition of intellectual disability (formerly mental retardation) from the 2002 manual (Luckasson et al., p. 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 operational variables included in AAIDD definitions have not changed significantly in 50 years (Schalock et al., 2007). Operational criteria for diagnosis have been generally consistent for the past 35 years, when the IQ criterion was changed from one to two standard deviations (Grossman, 1973). However, the construct underlying the term intellectual disability (and, thus, the constitutive definition of intellectual disability) has changed significantly over the last 2 decades due to the impact of the social–ecological model of disability (Institute of Medicine, 1991; Luckasson et al., 1992, 2002; WHO, 2001). In this model, intellectual disability is understood as a multidimensional state of human functioning in relation to environmental demands.This article focuses on supports and support needs, as they pertain to persons with intellectual disability, and closely related developmental disabilities. Definitions of each are as follows:This article is organized into five sections: (a) distinguishing the concept of supports from the construct of support needs; (b) conceptualizing supports as the bridge between “what is” (i.e., a state of incongruence due to a mismatch between personal competency and environmental demands) and “what can be” (a life with meaningful activities and positive personal outcomes); (c) considering support needs within a model of human functioning; (d) recommending an assessment and planning process to guide planning teams (and organizations) when developing and implementing individualized support plans; and (e) comparing and contrasting support planning with other planning approaches in the field of intellectual disability and related developmental disabilities.Supports are resources and strategies that enhance human functioning (Luckasson et al., 2002). Although this definition was developed with people with intellectual disability in mind, it is clear that everyone uses supports. The 17th-century theologian John Donne wrote, “No man is an island” (as cited in Jokinen, 2006) to convey the fundamental truth that human beings do not thrive in isolation from others. We live in an interdependent world and everyone needs a variety of supports to function on a daily basis. However, the types and intensity of supports needed by people with intellectual disability are different from those needed by most other people.Support needs, as we use it and position it within our understanding of intellectual disability, is a psychological construct referring to the pattern and intensity of support a person requires to participate in activities associated with normative human functioning. Multiple psychological constructs have been identified regarding both “states” and “traits” of humans. For example, anxiety, intelligence, happiness, and morality are all psychological constructs on which there are extreme points (e.g., euphoric vs. depressed) as well as many points in between, just like the construct of support 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. Addressing this congruence (i.e., ensuring person–environment fit) involves understanding the multiple factors that shape human performance, determining the profile and intensity of needed supports for a particular person, and providing the supports necessary to enhance human functioning.The concept of need generally refers to a condition characterized by the absence of some requisite necessity. Within professional literature pertaining to health, the concept of need has traditionally referred to a condition characterized as “a disturbance in health and well-being” (Donabedian, 1973, p. 62). Within psychology, need is defined as “what is necessary for an organism's health and well being” (Harré & Lamb, 1988, p. 409) or a motivated state resulting from “a feeling of unfulfillment or deprivation in the biological system…evidenced by a drive to complete such a lack” (Colman, 2001, p. 631). As discussed by Thompson and colleagues (Thompson et al., 2002, 2004b), support needs are identified on the basis of input from the individual and other respondents. Global (i.e., overall) support needs can be understood in at least four distinct ways:We do not see a person's support needs as necessarily or exclusively reflecting a disturbance of human capacity (although disability certainly may result in a disturbance of human capacity); rather, the person's support needs reflect a limitation in human functioning as a result of either personal capacity or the context in which the person is functioning. Like other psychological constructs, the level of a person's support needs (like the level of a person's motivation or shyness) is inferred and not directly observable. Moreover, an individual's support needs can be measured with varying degrees of accuracy by self-report and other report indicators of the intensity of support needs, such as is accomplished using the Supports Intensity Scale (Thompson et al., 2004a). To be clear, we see the support needs construct as reflecting more of an enduring characteristic of the person than simply a point-in-time description of the need for a particular type of support. People with intellectual disability are people who require the provision of ongoing, extraordinary (when compared with their nondisabled peers) patterns of support. Providing supports to people with intellectual disability enables their functioning in typical life activities in mainstream settings but does not eliminate the possibility that they will continue to need ongoing supports. Put another way, if supports were removed, people with intellectual disability would not be able to function as successfully in typical activities and settings.A major implication of conceptualizing intellectual disability as a state of functioning instead of an inherent trait is that the person–environment mismatch is addressed. The focus is not solely on “fixing” the individual. This implication is shown in the supports model depicted in Figure 1. First, in this model, a mismatch between personal competency and environmental demands results in support needs that necessitate particular types and intensities of individualized supports. Second, to the extent that these individualized supports are based on thoughtful planning and application, it is more likely that they will lead to improved human functioning and personal outcomes. As a bridge between “what is” and “what can be,” the focus of educational and habilitation service systems shift to understanding people by their types and intensity of support needs instead of by their deficits. Although there is a reciprocal relationship between impairments and support needs in that greater personal limitations will almost always be associated with more intense support needs, a focus on reducing the mismatch between peoples' competencies and the environmental requirements where they function, rather than a focus on deficits, is more likely to reveal supports that enhance personal outcomes.Figure 1 also illustrates two related global functions of individualized supports. The first function addresses the discrepancy between what a person is not able to do in different settings and activities and what changes–additions make that person's participation possible (e.g., promote human functioning). The second function of individualized supports focuses on enhancing personal outcomes by improving human functioning. Both functions need to be thoughtfully aligned.Sometimes, planning teams focus solely on what individuals can and cannot do in a variety of settings and, thus, arrange supports to empower individuals to do more things. Although this type of planning may lead to an individual's improved functioning, that individual's personal outcomes may not be significantly enhanced. Such planning may expand the activities available to the person and may even increase participation by the individual, but if these activities are not based on the person's preferences and priorities, any improvement in personal outcomes may be negligible. Equally misguided would be a focus only on personal priorities and preferences without thoughtfully considering the gaps between a person's competence and his or her environmental demands. This approach to planning increases the risk that supports will be arbitrarily applied. For example, an individual may want to live in his or her own home in the community, but may need some support that peers without disabilities will not need due to specific safety related concerns. A “throw in everything plus the kitchen sink” approach to supporting the individual might involve supplying staff inside the home 24 hr a day, 7 days a week who do all the cooking, cleaning, transporting, and so forth. Such excessive support provisions will not enhance the life experiences of the individual and will certainly result in wasting finite resources. Therefore, it is important to thoughtfully analyze and align both personal priorities and areas of need when planning and delivering supports.Supports are resources and strategies that enhance human functioning (Luckasson et al., 2002). Human functioning is enhanced when the person–environmental mismatch is reduced and personal outcomes are improved. Because human functioning is multidimensional, considering supports as a means to improve human functioning provides a structure for thinking about more specific functions of support provision.Human performance technology (HPT) theorists posit that human functioning results from interactions between a person's behavior and his or her environment (Gilbert, 1978). For example, Wile (1996), who created an HPT model by synthesizing five other leading HPT models, suggested that human performance is influenced by the following seven elements: organizational systems, incentives, cognitive supports, tools, physical environment, skills–knowledge, and inherent ability. Examples of support that correspond to each of Wile's human performance elements are listed in Table 1. Wile noted that some of these elements are external to the person (Elements 1–5), whereas others (Elements 6–7) are internal.Wile's (1996) seven elements are interdependent in terms of human performance and, more accurately, should be thought of as being cumulative. Therefore, from a supports perspective, solving a problem for any single element may be of limited value if problems with the other elements are ignored. As Edyburn (2000) pointed out when relating Wile's model to decision making in the area of assistive technology, getting a tool (Element 4) to improve performance would have a negligible impact if the person lacked motivation (Element 2) to be productive on the task for which the tool was to be used. Based on Wile's HTP model, supports should not be delivered to address discrete life activities or separate events, or be based on specific support individuals (e.g., job coaches, teachers). Rather, systems of support should be conceptualized where multiple aspects of human performance are considered in regard to multiple settings.It is not difficult to envision what a system of support would entail when considering the human performance elements in Table 1. Take the case of a man with intellectual disability working on a community job. The man in our hypothetical example was hired through an on-the-job-training (OJT) program offered by a state vocational rehabilitation (VR) agency (Element 1: Organizational Systems). This person was motivated to do well on the job because of opportunities for recognition and advancement (Element 2: Incentives), but he required assistance from coworkers on specific job tasks that he found to be difficult (Element 3: Cognitive Supports). In addition, this employee used assistive technologies to work more efficiently (Element 4: Tools) and needed to have the physical environment modified slightly to complete certain job assignments (Element 5: Physical Environment). Last, task analyses of aspects of the job were developed and then taught to him (Element 6: Skills–Knowledge), and he was matched to a job that was reasonably consistent with his unique talents (relative strengths) and personal interests (intrinsic motivation; Element 7: Inherent Ability). This example illustrates how each element of human performance was addressed through a system of supports, giving the worker a good opportunity to be successful on his job.An interesting implication of Wile's (1996) model is the role supports play at the organizational level. Although legislation is not considered an individualized support, it is evident that laws and regulations can have tremendous influence on people's lives. Consider the passing and subsequent reauthorization of the Individual With Disabilities Education Improvement Act of 2004 and its effect on opportunities provided to children with disabilities in the nation's schools. Prior to 1975, it was legal in many states to deny a child with special needs access to a public education. Although federal and state legislation, as well as local policies, would never be listed as distinct supports on individualized plans, it is important to acknowledge the influence that policymakers and advocacy organizations have had on the quality and quantity of supports that are available.Supports are a universe of resources and strategies that enhance human functioning. No individual will need all of the types of supports that are available. People's support needs differ both quantitatively (in number) and qualitatively (in nature). Planning teams are in the best position to identify the types of supports that people need. As shown in Figure 2, we propose a five-component sequential process for (a) identifying what the person most wants and needs to do, (b) assessing the nature of support a person will require to accomplish what he or she most wants and needs to do, (c) developing an action plan to garner and deliver supports, (d) initiating and monitoring the plan, and (e) evaluating personal outcomes. This support planning and implementation process has evolved from a planning process originally provided by Thompson et al. (2002, 2004b).The first component of this support process requires the use of person-centered planning (PCP) processes. A hallmark of PCP is the focus is on the individual's dreams, personal preferences, and interests. The primary purpose of a PCP process is to find out what is important to a person, and it is essential that discussions are not constrained by available services or by perceived barriers such as fiscal restrictions or limitations in a person's skills (O'Brien & O'Brien, 2002). As a team-planning method, PCP has been shown to yield better outcomes for adults with intellectual disability than do traditional methods of service planning (Holburn, Jacobson, Schwartz, Flory, & Vietze, 2004; Robertson et al., 2006). PCP processes involve the person with the disability and people important to that person. The desired outcome of PCP is a unified vision of a person's life going forward. This vision takes into account those aspects of the individual's current life that are favorable (i.e., aspects to maintain) and adds elements that will enhance his or her life in the future (i.e., aspects to change).The second component of the support process involves assessing the person's support needs. As one example, the Supports Intensity Scale (Thompson et al., 2004a) is a standardized measure used to evaluate an individual's support needs across seven life activity domains as well as to identify exceptional medical and behavioral support needs. However, any method that a planning team finds useful to assess support needs could be used, including direct observation of the person in variety of life activities and structured interviews with the person and his or her family members. The critical information to gather is the nature of the extraordinary support that a person would require to engage successfully in an array of those associated with the life priorities identified through support needs assessment and adaptive behavior assessment are both with typical performance in the two can be is important to that assessing a person's support needs is not the same as assessing his or her personal adaptive behavior assess the adaptive skills that a person has (and, thus, measure or performance associated with personal support needs assessment measure an individual's extraordinary supports needed to participate in the activities of daily life (Thompson et al., As discussed by and of the Association of of Developmental Disabilities support needs assessment to be most should have the following (a) be into and used by and with a of (b) consistent results and outcomes when used across service areas and (c) be person (d) and information to a of (e) identify the support needs of people with and results that are to decision making across a of and be to in the support planning process the of individuals support, their and and third component of the process on the first two to an individualized support the from the future to and it is important that an and plan of action be and Because a plan cannot address all priorities at one some personal priorities identified in 1 may need to be and some difficult may need to be However, the result of should be individualized plan that (a) the settings for and activities in which a person is likely to engage a typical and (b) the types and intensity of support that will be provided (and by (Thompson et al., p. component of the monitoring requires that planning teams the outcomes of the teams should a closely the extent to which the person's individual plan was should be ongoing and in terms of to the congruence between what was and what has to is on the extent to which desired life and personal outcomes are being This involves the individual's life experiences through the of personal outcomes. is important to acknowledge that personal preferences and priorities can over and this component of the process will assure that the when they continue to the person's needs. In addition, on personal outcomes can organizations and state systems with information regarding the extent to which systems are the needs of the field of intellectual disability, there are a of that can be used across individuals, and these are based on the assessment of domains and using both self-report and direct observation methods & 2007). Table 2 domains and indicators that can an at the level of the individual through the use of at the or systems level about the and current use of domains and indicators are found in the listed in the and in et al. should be noted there are a variety of terms across systems for the domains listed in Table the domains among the systems are when considering that these were developed by different at different and for different For example, and in the to the on and in the as well as to the and in the as by the Human and the Association of of Developmental Disabilities this five-component process requires a significant of and a planning process is essential to supports that are with individual needs and desired outcomes of people with intellectual disabilities. Planning teams can always to in the process when needed (e.g., if the plan was not due to the planning team would want to to and the In addition, the of should be as individuals and and require support The process always with assessing personal interests and needs for support, to team planning and is by monitoring of and with an of planning terms and differ as in an individualized support plan individualized service plan individualized program plan individualized plan individualized plan individualized rehabilitation plan individualized habilitation plan plan and individualized family service plan The or in between and plan may significant (e.g., age approach to for all practical planning others are structured by whereas others are of past and that have evolved over Although what a planning should is well the of this it is to between different approaches to planning and the need to support planning as a of any individualized considering different approaches to we that planning teams use only one to the of an individual's Multiple planning the risk of being as well as it would be for different organizations that are an individual in different to use a planning However, within an it would be best to use a single that for multiple planning We that a variety of planning approaches can be on individual and supports are resources and strategies that enhance individual functioning (Luckasson et al., we services as organized means for delivering supports, or other of assistance (e.g., For example, advocacy services a means for people to access a variety of advocacy supports, and such supports could from legal assistance to planning team an individual's services that intellectual and provides opportunities to skills. services medical to health problems as well as such as or physical all services will the same or quality of supports. between service might be due to different and or could be result of different of on our definition of service planning should focus on the types of services that need to be as well as the of that a person should have with a service (e.g., how many of service a person might need in a Because services are to supports and other of it is important for to have systems of A service planning component in an individualized plan is necessary to identify service who can deliver the supports or other types of assistance that is service planning is not a for support identifying of service or in which an individual is going to participate is to result in individualized supports or personal outcomes. in our distinguishing between support planning and service planning is not just an of Planning teams need to identify services an individual needs to but this is not the same as planning the patterns and intensities of supports a person needs to function in activities and settings consistent with his or her also differ from are in and planning where the focus is on and skills. Because the purpose of public and vocational rehabilitation (VR) services is to people in a positive way, and of However, support might involve educational settings for of the focus of support planning in such a case would be on participation plans, support are not characterized by and behavioral that for an individual. Rather, the function of support is to identify the resources and strategies that will bridge the between the that a person with intellectual disability experiences in life activities (i.e., person–environment and the life experiences and opportunities (i.e., that the individual the case of children who are teams are to in (e.g., as well as for However, planning and processes should also support For example, planning for the types of that will be to support a child to access the and an in the least environment would be to the of with intellectual disabilities. is important to that we are not that support planning should the focus of all individualized However, we are that the need for support planning should not be in where planning processes are the AAIDD the American Association on Terminology and Classification Committee the concept of supports in the manual (Luckasson et al., the that supports were an but essential In that the focus was on support resources other technology, and support functions (e.g., employee and and community access and support intensity of a supports intensity assessment and desired outcomes. A was between and supports. This to which at that to be to from individualized supports, which are based on the needs of the individual. a of support were offered on the basis of two (a) supports in and (b) support activities are by individuals or in that AAIDD manual (Luckasson et al., a better understanding of the for support provision and the need to supports in the context of an individualized process that and This understanding due to in the field between the and 2002 among these were (a) a greater of the value of PCP as well as implementation of PCP which personal and and (b) an approach to disability that the of person–environmental interactions and the of human functioning through the use of individualized (c) a on personal well quality of and personal and (d) an of support including in assistive we approach the and of the 11th edition of the there is that we can from past as well as In this we distinguished supports from support needs and discussed how on individual support needs can be through understanding of human In addition, we a supports model that illustrates how supports are a bridge between what is and what can be through the of the mismatch among a person's the demands of environment, and the of personal outcomes. We also a five-component process for and evaluating individualized supports 2) and suggested that support planning can other approaches to planning and in an individualized planning

Diagnostic Manual–Intellectual Disability: A Textbook of Diagnosis of Mental Disorders in Persons With Intellectual Disability, by R. Fletcher, E. Loschen, C. Stavrakaki, and M. First

Commentary on the 12th Edition of <i>Intellectual Disability: Definition, Diagnosis, Classification, and Systems of Supports</i>

Editorial: Introduction to Special Section on Evidence-Based Practices for Persons With Intellectual and Developmental Disabilities

The first plenary session of 132nd Annual Meeting of the American Association on Intellectual and Developmental Disabilities (AAIDD) reflected its support for basic and applied research to prevent or minimize the effects of conditions causing developmental disabilities, with Dr. Alan Guttmacher (2008), currently the acting director of the National Human Genome Research Institute, discussing the realized and potential benefits of genomics research on health and quality of life. This presentation dealt with an incredibly complex topic with clarity and sensitivity, and it was carefully neutral in tone and content with respect to intellectual and developmental disabilities. Nevertheless, a major implication regarding disabilities in general and developmental disabilities more specifically was quite clear. Current research in genomics, as well as in many other areas, is intended to improve understanding of the fundamental causes of disability to reduce risk, thereby lowering incidence of impairments and minimizing their severity. Should these goals be realized, the proportion of the population with disability would decrease, perhaps dramatically, and in some distant future significant impairments might even be eliminated altogether. As unachievable as that ultimate goal might appear to be, an assumption supporting many of the programs and much of the research agenda in the field of developmental disabilities is that we, as a society and as individuals, would be better off if physical, mental, and cognitive impairments ceased to exist.Yet, prevention encompasses many things and can be viewed from many perspectives, some of which have continued to challenge the universality of this assumption. There is a need for serious and open discussion of the many aspects of prevention within our field (and the disabilities field more generally) that entails explicit consideration of risks and benefits of specific programs and approaches to implementation. Although important distinctions can and should be made among primary prevention (avoiding the occurrence of a causal condition), secondary prevention (avoiding or minimizing the consequences of a causal condition after it occurs), and tertiary prevention (minimizing or improving outcomes after the consequences of a causal condition are evident), this dialogue needs to begin with consideration of the overarching goal of lowering the incidence and prevalence of impairments and reducing disability.In many respects, prevention was embraced long ago as a valued societal benefit, and this has had significant impacts in the case of intellectual and developmental disabilities. Certainly, the history of prevention in our own field has included some policies and actions that had devastating consequences for people with intellectual and developmental disabilities, and careful and constant vigilance will always be required to ensure that the rights, privileges, and dignity of every individual are respected and preserved. Nevertheless, many other aspects of the past continue to be broadly viewed as enormously beneficial, and several examples seem particularly illustrative.Until the late 19th century, congenital hypothyroidism (cretinism) caused many individuals in western Europe to have intellectual disability. For some alpine regions, it was so common an occurrence that local physicians thought it unremarkable (Merke, 1984). We now know that this condition is caused by dietary iodine deficiency, and this discovery, along with the availability of iodized salt, has virtually eliminated it as a public health concern in industrialized countries. (Nevertheless, congenital hypothyroidism remains one of the most common preventable causes of intellectual impairment in many underdeveloped regions of the world; Jain, Agarwal, Deorari, & Paul, 2008.)Prior to the 1950s, babies born with phenylketonuria (PKU), a relatively rare genetic disorder, were unimpaired at birth but invariably developed severe intellectual disabilities. This was caused by their inability to metabolize phenylalanine, a nutrient present in many everyday foods (including breast milk). Over time, the build up of abnormally high levels of phenylalanine has neurotoxic effects (Jervis, 1939), and, thanks to this discovery, a highly specialized diet was developed that has been successfully preventing disability in affected babies ever since. (All newborns in the United States are currently screened for PKU plus a growing number of other conditions, providing the basis for early diagnosis and prevention.)In the 1960s, a vaccine was developed with the intention of eradicating rubella (German measles), largely because infants exposed in utero were at high risk for intellectual and developmental disabilities. This vaccine has reduced the incidence of congenital rubella syndrome from 20,000 cases during the epidemic of the 1960s to less than 25 annually in the United States (U.S. Centers for Disease Control and Prevention, 2005). Current programs to reduce alcohol consumption by pregnant women are strongly endorsed and broadly supported for much the same reason, in this case to prevent fetal alcohol syndrome and related disorders, as is the use of folate supplements during pregnancy to reduce the incidence of neural tube defects (Pitkin, 2007). Obstetric practices have improved to avoid brain injury due to perinatal hypoxia and mechanical injury, as well as transmission of maternal viral infections that might affect babies' development. Environmental exposure to lead and mercury is being reduced to avoid their potentially neurotoxic effects, and the list could go on.Although these examples might suggest that there is no down side to prevention, the lessons of history show otherwise. Eugenics movements have gained momentum periodically, and there will always be some people in favor of imposing their views on those they see as less worthy than themselves. We are fortunate that we live in relatively enlightened times, but no matter how enthusiastic supporters of prevention may be, they must always be mindful of potential abuses. Furthermore, it must be emphasized that one of the most pressing issues facing our field has been conspicuously avoided in these examples: elective pregnancy termination based on the results of prenatal screening and diagnosis. Consideration of this critically important subject, along with the negative biases of many clinicians toward developmental disability (see Bauer, 2008), must be a major part of any dialogue about prevention. Even leaving this issue of life and death aside, though, an outspoken segment of our community vehemently opposes prevention. As expressed by the final comment from the audience at Guttmacher's (2008) plenary presentation identifying "the elephant in the room," some among us would "not want to live" in a world without intellectual and developmental disabilities. The commitment of this gentleman and his like-minded colleagues is beyond question, as is their regard for individuals with disabilities. However, other people share this commitment yet endorse the concept of prevention (although not necessarily all the strategies for possible implementation). The real elephant in the room, then, seems to be the question of whether a high regard for individuals with developmental disability inherently conflicts with support for prevention of the impairments affecting those very same people. There are certainly many ways to explore the answer to this question, but all of them should consider the logical connection between the two values in apparent opposition.Capturing the essential spirit of why people with intellectual and developmental disabilities should be valued as highly as people without disability, begin by accepting that (a) every person should have the same basic human rights and be recognized as an autonomous and unique individual and (b) each of us is capable of contributing in important ways to the diversity that enriches the human experience. In addition, accept that for every individual, each with his or her own unique profile of strengths and weaknesses, maturation and development depend critically on growth and change throughout the lifespan. Achievement of individualized successful development involves complex interactions among nature and nurture (and good fortune, no doubt), but specifics are unimportant for this discussion. It is only important to recognize that change is a natural part of life that incorporates growth, learning, and maturation and that individual characteristics must be viewed as dynamic rather than static.Once this is accepted, impairments, when present, should be recognized as just one type of personal characteristic among many, and, having no special status, impairments should also be viewed as dynamic and changeable. All treatments are based explicitly or implicitly on this premise, which is the driving force behind a host of programs that include access to a full and appropriate public education for all children (e.g., Public Law 94–142) and virtually all habilitation, education, and training. Shifting back to prevention, if impairments are subject to change, including reduction in severity, the logical foundation for opposing avoidance of their occurrence in the first place seems to collapse.As Guttmacher (2008) emphasized by the title of his plenary talk, "We Are All Mutants…," each of us is imperfect and vulnerable in one way or another. Any one of us can cross that threshold of impairment at any time, and in promoting acceptance of diversity and the value of people with disabilities, advocates serve all members of our society. Particularly at this juncture, when amazing advances in biomedical sciences and engineering are having dramatic impacts on practice and policy, it seems more important than ever to engage in an explicit evaluation of prevention and treatment from the diverse perspectives that make up the field of intellectual and developmental disabilities. A consensus is needed before the risks and benefits of specific policies, positions, and actions can be evaluated, and although that consensus might already exist outside of a small but vocal antiprevention minority, it seems at least as likely that core beliefs about prevention and treatment vary substantially. The stakes are enormous, and it would be incredibly useful to know the reality of current thinking.We each need to determine where we stand as part of the process of either building that consensus or determining that it can not be reached, and the process could start with each of us posing fundamental questions to ourselves and to others, such as: If impairments do not devalue individuals, why would successful treatment of those very same impairments? Does it follow that if successful treatment would not devalue these individuals, then prevention of impairments in others would not? Would we treasure our children with intellectual and developmental disabilities as much without their cognitive impairments? If we ever discover how to cure intellectual disability, should treatment be universally available? Has virtual eradication of congenital hypothyroidism in industrialized countries been beneficial, or have we tragically lost an entire class of people? Perhaps the most fundamental question of all is: What would we really think of a world where people without sight could see, where people unable to stand could run, and where people with intellectual disability were without their "significant limitations both in intellectual function and adaptive behavior" (American Association on Mental Retardation, 2002, p. 1)?Support was provided by Grant P30 HD024061 (M. Cataldo, Principal Investigator) from the Intellectual and Developmental Disabilities Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. I thank Drs. Michael Guralnick, Steven F. Warren, and Warren Zigman for many thoughtful comments on an earlier draft of this article.

In Atkins v. Virginia the U.S. Supreme Court declared execution of persons with mental retardation to constitute cruel and unusual punishment, and thus to be unconstitutional under the Eighth Amendment. However, the Court left all considerations regarding how to implement the decision explicitly to the states. Since Atkins was decided in 2002, legislatures, courts, and mental health experts have struggled with its implementation, highlighting the complexities that can arise when the courts base legal rules on clinical findings. This column reviews the Atkins case and considers the challenges associated with a clinical determination that can have life-or-death consequences for capital defendants.

Presidential Address, 2022-Dismantling Systemic Barriers: Re-Envisioning Equity and Inclusion.

Today, persons with intellectual and related disabilities are being seen as citizens in full standing in their own neighborhoods. We see them on the street, on buses, in restaurants—even attending classes in their own neighborhood schools and working at jobs they are able to do. It wasn’t always that way. In earlier years they were seen as objects of rejection. Most were removed from their communities and sent to live in large, out-of-the-way, state-funded institutions. Now that they are back in the midst of our neighborhoods, we are learning to understand and support them as never before. Most—but not all—seek to be friendly with local police officers. They do it because they need to depend on authority figures around them to live in the community successfully. Police officers need to know that some tend to be overly vulnerable and pliable when placed under pressure in interrogation rooms. In such a situation they may say whatever these authority figures want to hear. They will even confess to crimes they did not commit. Today, 53 persons with intellectual and developmental disabilities have confessed to serious felonies—murder, rape, arson, and robbery—that they did not commit. These cases have been extracted from three sources: They come from my own 30year collection of files and from sifting through a list of all false confessors produced earlier by two of the top experts on all false confessions (Drizin & Leo, 2004). More recently they have been sifted from a constant stream of false confession reports flowing out of the Center on Wrongful Convictions at Northwestern University’s School of Law. All of the 53 individuals have been legally exonerated. The number of persons on this list will increase in the years to come. For example, I can name 15 other false confessors with intellectual disabilities I believe to be innocent, but they will not be placed on this list until they have been exonerated by a formal legal action. Six factors gleaned from this list may be worth pondering:

Is the Intellectual Functioning Component of AAIDD's 12th Manual Satisficing?

In 2004, when I first started to investigate the history of the learning disability construct, I quickly found that the available literature on the topic fell into two categories, valid historical scholarship and celebrationist narratives. There were a small number of serious historical works by Carrier (1983, 1986, 1987) and Franklin (1987, 1994), who examined the growth of the learning disability diagnosis as a political and scientific development over many decades.I framed my own research in the tradition of Franklin (1987, 1994) and Carrier (1983, 1986, 1987), upholding the standards of research methodology and critical analysis set by historians (e.g., Danto, 2008; McDowell, 2002). My goal has been to determine where this notion of learning disability came from and how it grew in the work of many scientists over time. I have assumed neither that learning disability is a correct way of understanding the learning difficulties of some children nor that this construct was built as some sort of farce. I view the construct as a historical product, an idea cultivated through scientific practices and theories over generations of research.My research efforts resulted in a book entitled The Incomplete Child: An Intellectual History of Learning Disabilities that chronicled the scientific ideas and practices that brought about the learning disability construct (Danforth, 2009). It is a story of multiple lines of intellectual traditions conflicting and melding, of pre-WWII German holistic science blending with Chicago School functionalism and the environmentalism of the Iowa Child Welfare Research Station.In addition, I have written a recent series of articles, including the Intellectual and Developmental Disabilities piece that I co-authored with Laura Slocum and Jennifer Dunkle. In these historical articles I addressed topics ranging from the pronounced social class bias of learning disability researchers of the 1960s and 1970s (Danforth, in press, a) to the 1970s epistemological shift toward objectivism (Danforth, in press, b).The Mather and Morris (2011) response paper belongs to the celebrationist category of historical writing that does not meet the standards of methodological rigor and critical analysis set by professional historians. This paper continues a professional line of insider accounts, self-congratulatory, poorly researched historical overviews written by special educators that celebrate the field and its pioneers (e.g., Cruickshank & Hallahan, 1981; Hallahan & Mercer, n.d.; Hallahan & Mock, 2003; Wiederholt, 1974). These works, although often informative, are overwhelmingly acritical. The authors fail to ask serious and troubling questions about the development of the field and the social impact of the ideas in the field. The purposes and the work in the field are lauded without the kind of rigorous scrutiny that historians apply to their subject matter.In their paper Mather and Morris's (2011) attempt to preserve "the legacy that Dr. Samuel A. Kirk left behind" (p. 118). Their primary goal is to perpetuate a purified narrative of a man living, thinking, and acting without contradictions and errors, without moral uncertainty and fallibility.The truth of the matter is that Sam Kirk was far from clear and definitive in his handling of the learning disability construct. In fact, he articulated 16 substantively different versions of the learning disability construct.I devote an entire chapter in my 2009 book to this issue. In this short rejoinder, I briefly illuminate Kirk's multiple contradictory articulations of the concept of learning disability between 1960 and 1984. Then I probe for possible lessons we might draw from Kirk's inconsistencies.In the course of my historical research, I examined every published work that Kirk ever authored or co-authored. Further, I conducted a thorough exploration of his archival materials—many boxes of personal papers such as letters, notes, unpublished presentations—stored at the University of Illinois, Urbana, which allowed me to gather many speeches to professional groups that were never published.Archival research is considered a foundational method of doing historical research. I note that Mather and Morris (2011) did not reference the extensive Kirk archives, suggesting that they took a highly problematic short-cut. I gathered documented records of 18 professional speeches and published writings in which Kirk offered a complete description of the learning disability concept between 1960 and 1984.In order to focus on the actual ideas used to build the learning disability construct, I have identified 15 separate conceptual components that Kirk used and reused over the years. Each component was a semantic building block, a single meaningful element that made a substantive contribution to the larger definition of the disorder.Table 1 presents the 15 conceptual components present in each of the 20 articles or speeches that Kirk made between 1960 and 1984. The components utilized in describing the learning disability concept are labeled with the letters A through O.Components A through C involved etiological theories that posited a causality for the learning difficulty.Components D through I were exclusionary factors, reasons for the learning difficulty that, if present, indicated that the problem was not a learning disability.Components J through N described the comorbidity of learning disability with other childhood disorders. J represents a high level of correlation between learning disability and emotional or behavioral disturbance, such that the two disorders were understood to be constitutionally linked. Components K through M indicate a co-occurrence of distinct disorders. Learning disability and each disorder could co-occur to create what Kirk called a "double handicap" (Kirk, 1967a), but the two impairments were framed as essentially unrelated.Component N involved Kirk's attempt to distinguish between levels of mental retardation in relationship to the learning disability diagnosis. Due to the general and total nature of the intellectual deficit, severe mental retardation was understood to be a disorder quite unlike a learning disability; but mild mental retardation, he sometimes claimed, proved to be only a learning disability concealed behind a diagnostic disguise. Proper educational treatment would bring to light the concealed mental assets, the hidden potentials, in order to demonstrate when mild mental retardation was actually a learning disability.O proposed that students with learning disabilities required a special education program consisting primarily of diagnostic–remedial instruction.Of the 18 complete articulations of the disorder, only two pairs (2, 3 and 15, 17) were completely consistent with one another. The record of complete conceptualizations consists of 16 distinct delineations of the disorder over 24 years. Simply put, Kirk devised 16 variations of the learning disability construct.As Kirk worked in the 1960s to promote acceptance of the new learning disability construct, he repeatedly tried to explain how it related to the older, more established, and greatly trusted classification of children with mental retardation. Kirk's seemingly endless struggle to make this relationship clear is a frustrating tale of theoretical ambiguities and rhetorical miss-steps.In early 1963, separated only by 3 months, Kirk delivered two remarkably different speeches. In January, he spoke to a small conference of brain injury researchers at the University of Illinois, a group that included Newell Kephart, Helmer Mykelbust, and Joseph Wepman. At the Chicago meeting of neurological scientists, he said that learning disability refers toIt was a disorder of the psychological processes with possible etiologies of neurological damage or emotional disturbance. Mental retardation was listed among the excluded conditions.Later in the same presentation, however, Kirk appeared to backtrack on this, stating that learning disability "does not refer to most mentally retarded children since the discrepancy between their ability and their achievement is not great" (Kirk, 1963a, pp. 49–50). His frequent use of the modifiers generalized and most muddied up his assertion that mental retardation was an exclusion.Latour and Woolgar (1979) called words such as these "grammatical modalities" that operate as "an expression of the weight of a statement" (p. 84), a register of factual status. A modality can be used to either increase or decrease the degree of rhetorical facticity. Similarly, linguists use the term hedge to describe a word or phrase that effectively dilutes the certainty, authority, or truth value of a statement. Lakoff (1972) defined a hedge as language "whose job it is to make things fuzzier" (p. 195).Kirk demoted the truth value of his statements, creating some room for doubt or alternative interpretation. Perhaps children whose mental retardation was not "generalized" could also have a learning disability.Three years later, in 1966, he would more fully assert that very claim. If a child with mental retardation "has discrepancies among abilities, or if he has special abilities and marked disabilities, he could be classified as a child with a learning disability as well as overall mental retardation" (Kirk, 1966, p. 2). One could have a generally depressed profile of intellectual ability that still included significant gaps between high and low areas of functioning. He would articulate this same notion of possible co-morbidity of mental retardation nine times between 1963 and 1984 (see Table 1).In the second of Kirk's 1963 speeches, speaking to a very different audience of parents and advocates, he presented a definition of learning disabilities that differed dramatically from his statement to the gathering of scientists:He dropped all possible etiologies of the disorder, including cerebral injury and emotional disturbance.In this revision, the phrasing concerning mental retardation constituted an unequivocal exclusion. Contrary to what Kirk had suggested with the modifiers "most" and "generalized" a few months earlier, a child with mental retardation could not also have a learning disability.It seems that Kirk's presentation to the conference of parent advocates was, at least to some extent, a case of telling the audience what they wanted to hear. His presentation distanced learning disability from the highly stigmatized category of mental retardation. He avoided any discussion of the causes of the learning problem. If he had used any of the standard etiologies (e.g., brain injury, flawed genetic inheritance, or deficient environmental stimulation), the many parents in the audience might have squirmed at the suggestion of blame.Quite likely, Kirk felt pressured by parents to make certain statements in his speech. He later admitted to having mixed feelings about providing a definition of learning disability at the conference. He was wary about adding yet one more diagnostic label of questionable pedagogical value to the professional compendium (Kirk, 1976). During the speech, right before providing a definition for learning disability, he professed to the audience his strong reluctance to do so.Kirk invested far more time and words attempting to convince the listeners to disregard disability definitions than actually offering a definition of learning disability. Later, he recalled that "several [parents] approached me with the admonition that they needed help in the selection of a name for their proposed national organization" (Kirk, 1976, p. 255). Accompanied by words of caution and even mild protest, Kirk gave the parents what they wanted.What we find in this historical analysis is that Samuel Kirk is not a purified icon or an idealized figure gilded in a glorious legacy. We view him as a real person, someone attempting to deal quite awkwardly with too many concepts, constraints, and pressures. As the most famous special educator in the United States during the period of rapid growth in the years immediately prior to and following the passage of P.L. 94–142, Kirk was a political actor tugged in every possible direction. His scattered and often contradictory words left a zigzag trail that attests not only to the "religious revival" (Frierson, 1976, p. 139) emotional tone of the early learning disabilities movement. It also indicates just how difficult it is to use language to pin down an authoritative concept once and for all.I do not believe that Samuel Kirk needs defending. The importance of his contributions to the field of special education is undeniable. In the narrative of the growth of American special education in the latter half of the 20th century, Kirk is the clear hero.Our more practical challenge is to draw useful lessons for today from Kirk's contradictions. Although he was a staunch proponent of the idea that all children can learn, on one spring day in 1967, in a speech at the University of Minnesota, he contradicted his usual message. He used mental retardation as a contrasting foil, a less educable population, in his effort to explain the intellectual capacities of children with learning disabilities (Kirk, 1967b).What does it mean to us when a special education hero stumbles?One possible lesson concerns the cultural pervasiveness of an ugly politics of disability that punishes those deemed furthest from notions of "normal." Even Kirk—even the great Kirk—slipped into this quagmire of disability politics, pushing down on mental retardation in order to elevate learning disability as a disorder likely to respond positively to intervention.In 1967, just as today, a cruel political discourse that devalues persons with mental retardation labels was readily available and too-often employed, even by well-known educators and psychologists. When Kirk praised the educational potential of learning disability in contrast to that of the lesser mental retardation, he stepped into a political pothole that was not of his invention (Kirk, 1967b). He found it nonetheless. He found it quite easily because it was conventional thinking about persons with mental retardation.Kirk's stumble may tell us that the cruel politics of disability that diminishes persons with the mental retardation label (or intellectual disability in current terms) to the bottom of the social hierarchy is not completely divorced from the intellectual and practical traditions of the field of special education. Certainly, the modern American field of special education was founded on Kirk's idea that students conventionally thought to have little or no educational potential deserve public school instruction. But the field, like Kirk, is filled with contradictions.The contribution of the field of special education to the political devaluation of students with disabilities in the schools has been the subject of concern among many scholars (e.g., Brantlinger, 2006; Harry & Klingner, 2006; Ware, 2004). Illuminating the politics of disability in the schools and combating social injustice requires that we honestly and fully acknowledge how standard special education beliefs and practices can operate to stigmatize and isolate children. Toward this end, we should devote less energy to the perpetuation of idealized historical legacies that avoid the unsavory and problematic. We should expend far more energy confronting the cultural devaluation of children with disabilities in our schools and communities.

In this response to Bellini's (2007) commentary on "Defining Mental Retardation: A Matter of Life and Death" (Lichten & Simon, 2007), we summarize the major issues in defining mental retardation and respond to several points raised by Bellini (2007). We are also aware of and support the change in nomenclature from mental retardation to intellectual disability, as advocated by the American Association on Intellectual and Developmental Disabilities (AAIDD). However, during this transition period, the existing diagnostic guides and state statutes have not yet changed to the more current term, intellectual disability. Therefore, we base our discussion on AAIDD's (formerly the American Association on Mental Retardation [AAMR]) Mental Retardation: Definition, Classification and Systems of Supports (Luckasson et al., 2002) and use that nomenclature throughout.Since Heber (1959) introduced the requirement that both IQ and adaptive behavior be a part of the diagnosis of mental retardation, the AAIDD manual (Luckasson et al., 2002) has moved gradually in the direction of relying on standardized tests of adaptive behavior. However, the 2002 manual does not define how both measures should be combined. The manual states for IQ scores that, "The criterion for diagnosis is approximately two standard deviations (SD) below the mean" (p. 14). For measures of adaptive functioning, it states that:Lichten and Simon (2007) pointed out that imposing both conditions (IQ and adaptive behavior), as Luckasson et al. (2002) directed, would drastically reduce the prevalence of mental retardation in the general population. The exact degree of this reduction would depend on the correlation coefficient between the standardized IQ and adaptive measures used. Because correlations between IQ and adaptive measures are usually small, we provided an example in which the correlation was zero. We then found that the current prevalence of 2.3% (approximately 6.8 million people with mental retardation in the United States) would be reduced to the absurd 2.3% of 2.3%, or 0.053% (approximately 160,000 people with mental retardation in the United States). (With a correlation of .2, the number of persons with mental retardation would equate to approximately 400,000, still an absurd figure; Lichten & Simon, 2007.) Clearly, for everyday clinical diagnostic use, the Luckasson et al. (2002) criteria need revision.In our article (2007), our solution to the above problem was to use the standard method in constructing scales, such as for IQ or adaptive behavior. Scale authors, such as Wechsler (1974) or Sparrow, Balla, and Cicchetti (2005), started with multiple measures of the traits they wished to study. They then combined these measures into a single scale. Conventionally, this combined scale has a mean of 100 and standard deviation of 15.We followed the same method in combining IQ with adaptive functioning. The example we chose combined commonly used and well-standardized IQ (Wechsler, 1974, and/or Stanford-Binet [Roid, 2003]) and adaptive behavior measures (Vineland Adaptive Behavior Scales; Sparrow, Balla, & Cicchetti, 2005). We preferred these scales for our example largely because the data quality seemed best to us. Nevertheless, our method was general and required only the correlation coefficients among the scales to be combined. Thus, the method can handle any of the types of standardized measures specified by Lukasson et al. (2002, see previous quotation), if the requisite correlation coefficient is available.We find that the commentary by Bellini (2007) revealed a selective use of information in our article (2007) and the manual (Luckasson et al., 2002): Quoting from Bellini (2007),Part (b), omitted by Bellini (2007), allows use of total adaptive behavior scores. Bellini's comment is a selective presentation of the full definition. There is no disagreement between our assumptions and the AAIDD handbook (Luckasson et al., 2002).Furthermore, the use of the Vineland Adaptive Behavior Composite score is not necessary for our argument; we used it as an example. One can use either recommendation of Luckasson et al. (2002; i.e., use of a single domain score or a total adaptive behavior score) in constructing the Total Quotient (TQ). The only required information is the correlation coefficient between IQ and the chosen measure. Therefore, there is no disagreement between us and Luckasson et al. (2002).In his commentary, Bellini (2007) also criticized the TQ index as being inadequate. He overlooked repeated statements in our article that expressed the need for clinical judgment in addition to our quantitative measure. For example,We find no real disagreement between our article (2007) and Bellini's (2007) commentary. We certainly agree with Bellini that "institutional decisions … in the lives of individuals should be based on a comprehensive assessment" (p. 348). Nevertheless, past history has shown that diagnoses rely heavily on quantitative data, which is why we constructed the TQ.Bellini (2007) further criticized TQ as follows: "Use of TQ as a diagnostic benchmark would likely create greater ambiguity in classification because individuals with other disabilities … who currently do not meet all relevant criteria for mental retardation could qualify using the TQ benchmark" (p. 349). Our discussion (2007) of TQ also clearly pointed this out: "TQ also does not obviate the use of sound clinical judgment by trained professionals in assigning a diagnosis of MR that would otherwise result in misdiagnoses in such cases as depression, physical and sensory challenges, or the inappropriate use of standardized tests" (p. 341). Bellini (2007) also posited the importance of context, such as the level of support, in evaluating mental retardation. He then suggested that TQ is inadequate because it fails to take context into account. We do not disagree with the possible importance of such factors. However, present definitions of mental retardation (Luckasson et al., 2002) emphasize standardized measures: IQ and adaptive functioning. What we have done is to solve the problem of entering both factors into the definition of mental retardation without changing its prevalence—nothing more, nothing less (Note: Bellini presented the well-known distinction between precision and accuracy. We don't disagree with his distinction but find it irrelevant to our discussion of TQ. The word precision never occurred in our article.)We have implemented the present definition of mental retardation (Luckasson et al., 2002) with a simple combination of both IQ and adaptive functioning scores (Total Quotient), which keep the prevalence of mental retardation constant. We find that Bellini's (2007) criticisms were based on a selective reading of our article (Lichten & Simon, 2007) and that of Luckasson et al. (2002). He criticized our article for not going beyond the current definition of mental retardation by Luckasson et al., by including additional factors that he felt should be included in the definition. Yet we believe that we made a positive contribution to the definition of mental retardation by enlarging the number of multiple indicators. TQ, as exemplified by us, extends that number from 10 in IQ to 21 in both IQ and adaptive functioning. We consider this an advance but not the last word, as the concept of intellectual disability continues to be specified.

In a recent issue of Intellectual and Developmental Disabilities, Danforth, Slocum, and Dunkle (2010) discussed the historical contributions of Dr. Samuel A. Kirk, a well known special education pioneer and psychologist, to the fields of mental retardation (now known as intellectual disability) and learning disabilities. Although we agree with some of the authors' points—including the assertion that Kirk had a powerful influence for decades on the development and delivery of special education services for all children—several of their statements do not appear to represent Kirk's viewpoints accurately or provide adequate representations of the origins and conceptual foundations of the learning disability field and its relationship to mental retardation. In order to set the record straight, we have used Kirk's exact words within this response from his publications over his lifetime to place into proper historical perspective his views on the origins of the learning disabilities field, as well as the relationship between mental retardation and learning disabilities. Contrary to the statements made by Danforth et al., we maintain that Kirk's beliefs concerning mental retardation and learning disabilities were not complex and confusing.In fact, the claims made by Danforth et al. (2010) seem to us to be the result of a bit of revisionist history. In this article, we discuss several of Danforth et al.'s comments, including (a) the history of the learning disability construct, (b) Kirk's three claims regarding the constructs of learning disability and mental retardation, (c) the concept of intraindividual differences, (d) the assertion that Kirk left children with mental retardation behind, and (e) the belief in the educability and potential of all children.Danforth et al. (2010) asserted thatKirk did not believe that learning disability was a "recent invention," or that it was "crafted as a conceptual outgrowth of the mental retardation construct," or "developed by researchers working with children with mental retardation." The origins of the conceptual foundations of learning disability are nearly as longstanding as many of the other disability categories, and the roots can be traced back to at least the early 1800s (Hallahan & Mercer, 2002; Hammill, 1993; Wiederholt, 1974). In fact, Kirk often noted that the most common learning disability, dyslexia or specific reading disability, has been studied for over a century and has its own history that is totally separate from the history of mental retardation. In this regard, Kirk and Gallagher (1983) stated:Kirk (1974) further wrote: "Disabilities in reading, writing, and spelling have been of interest to neurologists, ophthalmologists, psychologists, and educators since and before the beginning of this century" (p. 1).Danforth et al. (2010) noted that the conceptual and diagnostic basis for learning disability evolved from the "Strauss syndrome." Although Kirk was highly influenced by the work of Alfred Strauss and acknowledged the contributions of Strauss by explaining that "Strauss gave the initial impetus to the field of learning disabilities" (Kirk & Chalfant, 1984, p. 30), he always maintained that "The discipline now called learning disabilities had its beginning in the early contributions of neurologists who studied the loss of language in adults and ophthalmologists who were concerned about children's inability to develop language or to read or spell" (Kirk & Chalfant, 1984, p. 21). For example, throughout his writings, Kirk discussed how the origins of specific reading disability can be traced back to the 1800s when various physicians studied brain injury in patients who had lost the ability to read (Kirk & Chalfant, 1984; Kirk & Gallagher, 1983). Physicians from the United Kingdom, Germany, and the United States provided the first case studies of individuals who had lost the power to read—usually because of a stroke or brain injury—and these physicians attempted to identify the characteristics, etiology, and methods that would be most effective for treating these reading disorders (Anderson & Meier-Hedde, 2001). As an example, in 1872, Sir William Broadbent described the cortical damage present in an autopsy of an individual who had speech disturbances and reading disabilities (Broadbent, 1872). Five years later, Kussmaul (1877a) noted that "a complete text blindness may exist although the power of sight, the intellect, and the powers of speech are intact" (p. 595). In this regard, the term word blindness was first applied to individuals with aphasia who had lost the ability to read (Kussmaul, 1877b). Thus, Kussmaul gave birth to the idea of specific reading disability (Hallahan & Mercer, 2002), a type of learning disability that Kirk would study his entire career (Kirk, 1984).From early in his career, Kirk was fascinated by the enigma of children with specific reading disabilities and how they could be best served. In 1929, he began his master's degree at the University of Chicago. During his graduate studies, he also worked as a resident instructor at the Oaks School in Oak Park, Illinois (a suburb of Chicago), where his job was to manage 50 delinquent boys who had mental retardation (Kirk, 1984). He worked at the school under the tutelage of Dr. Marion Monroe, a researcher at the Institute for Juvenile Research in Chicago and a leading reading expert who had originally worked with Dr. Samuel Orton in Iowa. Orton is often described as providing the first report on word blindness in America and as being the key figure for setting the stage for the study of reading disabilities in the United States (Hallahan & Mercer, 2002).Kirk, therefore, had parallel interests in both mental retardation and the concept of reading disability, dating back to his early graduate studies and his work experiences at the time. Reflecting on his experiences at the Oaks School, Kirk (1976) stated:Kirk's first publication based on his master's thesis was a study that explored the learning of simple words by what he referred to as "subnormal boys" (Kirk, 1933). He later explained (Kirk, 1984):As did Fernald, Orton, and Monroe, Kirk found that retention for word learning was improved when tracing was added to the teaching procedure. Kirk (1984) also hypothesized at this time that "remedial reading might alleviate delinquency in some children" (p. 29).As was the case with other early pioneers, Kirk was concerned about finding the most efficacious ways of instruction for children who were struggling to learn to read. Kirk (1984) explained how Monroe's 1932 book, Children Who Cannot Read, was for a while his "bible" (p. 31) and how her system of diagnosing reading errors and profiling abilities and disabilities continued to influence his work in later years. In discussing Monroe's remedial program, Kirk noted that "Her remedial work was continued by two of her students who studied with her at the Institute for Juvenile Research in Chicago" (Kirk & Chalfant, 1984, p. 32). These two students, Thorleif G. Hegge and Samuel A. Kirk, along with his wife, Winifred, went on to develop the Hegge, Kirk, and Kirk Remedial Reading Drills (1936), which evolved from the study of children with reading disabilities, and their development was "influenced by Marion Monroe and the Fernald kinesthetic method" (Kirk, 1984, p. 32).Monroe (1932) also created an expectancy formula as a way of identifying reading disabilities that was based on comparing a child's chronological age, mental age, and arithmetic ability to reading performance (Hallahan & Mercer, 2002; Monroe, 1932). The resulting discrepancy indicated the severity of the reading disability. Influenced by Monroe, Kirk (1962) recommended that for diagnosing severe reading disabilities (dyslexia), one would determine a child's reading potential or capacity by comparing his or her Stanford-Binet IQ score and measures of vocabulary and arithmetic computation to the present level of reading achievement (pp. 265–266). This type of discrepancy expectancy formula or ability-achievement discrepancy was incorporated into P. L. 94–142, Education for All Handicapped Children Act (1975).Danforth et al. (2010) asserted that Kirk's own thinking about the relationships between mental retardation and learning disabilities was complex, multifaceted, and confusing. They noted that Kirk made the following three claims: (a) mental retardation was an exclusionary criterion to learning disability, (b) a child could have both a learning disability and mental retardation, and that (c) "learning disability was often mental retardation in disguise" (p. 189). Although it is understandable how readers unfamiliar with the origins of these fields could view such claims as "complex and even confusing" (p. 188), Kirk, in fact, viewed them as quite consistent as we discuss below.Danforth et al. (2010) indicated that Kirk "came to believe that he could not promote the new learning disability construct without clearly distinguishing it from the older, more established condition of mental retardation" (p. 182). On the surface, Danforth et al.'s statement is true. In fact, Kirk (1977) stated that the characteristics associated with learning disabilities were distinguishable from those associated with mental retardation, and in his scholarly endeavors and governmental public policy work during his years in Washington, DC, he attempted to differentiate between these two constructs. Kirk was well aware that federal legislation in the late 1950s and early 1960s already provided teacher training for students having mental retardation (e.g., P.L. 85–926, National Defense Education Act of 1958, that provided funds for training professionals to train teachers of students having mental retardation) and for students who were deaf (e.g., PL 87–276, Special Education Act of 1961, that provided funds for training professionals to train teachers of students who were deaf) (Kirk, 1984).Just as he had done for children having cerebral palsy or mental retardation, Kirk wanted to create another category of special education that would protect and provide services for children with specific learning disabilities. In discussing the category of learning disabilities, Kirk and Gallagher (1983) explained: "The label learning disability includes the heterogeneous group of children who do not fit neatly into the traditional categories of handicapped children" (p. 366). In the 1950s and early 1960s, public schools did not provide special educational services for these children. Kirk and Chalfant (1984) explained that the field of learning disabilities emerged for the following two reasons:Hammill (1993) also agreed that the most influential group in the learning disabilities movement were parents; it was their advocacy work that was primarily responsible for the specific legislation that was passed. In fact, Kirk often noted the important role and success of parents and parent groups, such as the Association for Children with Learning Disabilities, in establishing through litigation the rights of their children with disabilities (Kirk & Gallagher, 1983, p. 15).Kirk attempted to differentiate between those learning disabilities that were attributed to a neurological impediment that resulted in a specific academic problem from the more generic learning problems in children that could result from limited school attendance, inadequate instruction, or other environmental conditions. Such children were excluded from the learning disability category because their difficulties could be attributed to a lack of opportunity to learn (Kirk & Gallagher, 1983). In 1963, Kirk was invited to speak at the Conference on Exploration Into Problems of the Perceptually Handicapped Child. He proposed that the term learning disability be used to categorize these children who did not fall into the traditional categories of disability, but nevertheless had learning impairments (Kirk, 1984).Kirk was also concerned that learning disability would become a category for all types of learning problems when it was meant to capture only those individuals with specific disabilities that did not interfere with all types of learning. He found that the field of learning disabilities was experiencing the same type of problems with expansion and misidentification as did programs for the educable mentally retarded, stating:Kirk, therefore, was very concerned about differentiating between children having mental retardation, where their learning was negatively affected across many academic and adaptive learning skills areas (e.g., reading, math calculation, spelling, writing, social interactions, eating, dressing) from those having a specific learning disability within one or more academic areas (e.g., reading and/or math calculation).Danforth et al. (2010) noted that "Kirk steadfastly maintained that, in some instances, a child could have both a learning disability and mental retardation" (p. 187). This statement is true and an accurate reflection of Kirk's beliefs. Because Kirk viewed a learning disability as a perceptual impairment, a person of any level of intelligence, including intellectually gifted individuals, could have a learning disability. In an interview with Arena (1978), Kirk explained this conceptualization of learning disability: "I like to define a learning disability as a psychological or neurological impediment to development of adequate perceptual or communicative behavior, which first is manifested in discrepancies among specific behaviors or between overall performance and academic achievement" (p. 617). Kirk, Kliebhan, and Lerner (1978) also noted that "the concept of discrepancy applies to mentally superior, mentally normal, and mentally retarded children" (p. 27). Thus, Kirk did maintain that individuals of any level of intelligence and with any other disability could also have a learning disability. He understood that comorbidity can exist among numerous disorders, such as a child having both a sensory impairment and mental retardation or a child having both a learning disability and physical impairments. Kirk (1962) explained this in the following manner:Thus, for Kirk a learning disability differed from mental retardation in that it stemmed "from intrinsic cognitive or perceptual difficulties interfering with a child's learning" (Kirk, 1984, p. 40). He further stated:Children who have mental retardation or an emotional disability could also have an intrinsic neurological impediment to learning; and these children would be considered to be "multiply handicapped and remediated as such" (Kirk & Chalfant, 1984, p. 16). Thus Kirk noted that learning disabilities are "not primarily due to severe mental retardation, sensory handicaps, emotional problems, or lack of opportunity to learn" (Kirk & Gallagher, 1983, p. 368).Kirk was always concerned about misclassification of children because it would lead to inadequate understanding of the child as well as inappropriate instruction. Kirk and Chalfant (1984) stated: "In classifying children for instructional purposes, considerable care must be taken to avoid mistaken diagnoses and misclassifications" (p. 14). Kirk was well aware that children could be diagnosed as having mental retardation when, in fact, they did not. He found that some children who were classified as having mental retardation would be better classified as having learning disabilities. Throughout his career, he stressed that the diagnosis of children was for the purpose of remediation, not for classification or categorization. In this regard, Kirk and Johnson (1951) stated: "The purpose of any diagnosis, or the determination of etiology, is to assist in structuring the most adequate rehabilitation procedures" (p. 109).Kirk always viewed the concept of intraindividual discrepancies as a defining feature of learning disabilities, with Kirk and Gallagher (1983) stating the following: "Although such children form a heterogeneous group and fail to learn for diverse reasons, they have one thing in common: discrepancies (intraindividual differences) in abilities and achievement" p. 366). Regardless of the type of disability, however, Kirk was always interested in the concept of intraindividual differences, specifying what children could do, what they had difficulty doing, and, most importantly, how to resolve their difficulties. He commented: "I have felt for some time that labels we give children are satisfying to us but of little help to the child himself" (Kirk, 1975, p. 8). He felt that labels did not translate into intervention needs, and these needs could only be determined through thorough study of each child. He wrote: "Their classification as mentally retarded had little relevance to the training of these children. Each child needed a diagnosis, and each child needed a different program (Kirk, 1984, p. 37). Kirk always asserted that instead of using labels "it is more accurate and meaningful to describe behavior" (Kirk, 1975, p. 9). When evaluating children with mental retardation, he asked the following questions: "What abilities does this child have? What deficits exist? What do we do about these particular deficits?" (Kirk, 1984, p. 37).These types of questions led Kirk to develop a test of specific perceptual and linguistic functions, the Illinois Test of Psycholinguistic Abilities–ITPA (Kirk, McCarthy, & Kirk, 1968). Profiles were used to identify a specific child's strengths and weaknesses for the purpose of planning the most appropriate educational intervention. Kirk (1962) explained the importance of profiles, stating: "The profiles showed typical assets and deficits in growth which necessitate different educational methods and programs for various types of deviant children; the gifted, mentally retarded, auditorily handicapped, visually handicapped, speech handicapped, crippled, socially maladjusted, and multiply handicapped" (p. 32). Kirk (1984) further observed that "the ITPA was popular from the beginning because it is an intraindividual test, comparing a child's own abilities and disabilities for the purpose of organizing remediation for deficits" (p. 38).Throughout their article, Danforth et al. (2010) suggested that Kirk's turning of his "educability narrative" was a way to promote the learning disability construct while negating mental retardation. In describing how Kirk's viewpoints changed, Danforth et al. stated:Danforth et al. further explained thatDanforth et al. (2010) asserted that "Students with learning disabilities were nuggets of gold among the coal heap, untapped assets buried within a defective population, awaiting discovery and instructional polishing up" (p. 190) and thatThus, Kirk is portrayed as turning away from the population of children having mental retardation, essentially leaving these children behind, in a "coal heap" because of their limited learning potential. Danforth et al. did, however, note at one point that Kirk "remained a strong supporter of the educational training of students with mental retardation throughout his career" (p. 190), but later, they more negatively claimed that this message was somehow lost or obscured and that he "also negated that very message in certain circumstances" (p. 190). In addition, in discussing a quote by Kirk, Danforth et al. explained that Kirk asserted that although a child with mental retardation required "care" and "management," the child with learning disabilities had assets and disabilities that may be amenable to remediation.To set the record straight, Kirk never negated the message of being a strong supporter of the education and training of students with mental retardation; he only attempted in many of his publications, speeches, and federal government public policy work to clarify the similarities and differences between mental retardation and learning disabilities. Moreover, concerning the aforementioned comment by Danforth et al. (2010) regarding the "care" and "management" quote by Kirk in relation to mental retardation, readers of this Journal and Danforth et al. should be aware of the fact that Kirk stated that the label of mental retardation applies to children who require "certain kinds of care, management, and education [italics added]" (Kirk, 1967, p. 13). Education was never excluded by Kirk from care and management, as Danforth et al. suggested.Kirk believed that all children, regardless of type of disability, had learning potential and would be responsive to educational intervention and treatment. He commented that his experience at the Wayne County Training School "pointed out to me that much more could be done with handicapped children than most people believed" (Kirk, 1984, p. 32) and "biased me toward a belief in the power of intervention" (Kirk, 1984, p. 35). Throughout his career, Kirk was a champion for children with all types of abilities and disabilities, including those who were gifted. He was concerned with the accurate identification of disabilities for ensuring the most effective services. Kirk would not agree that he turned his back on children having mental retardation or that these children had limited learning potential. In fact, he commented that throughout his career, it was "a great source of satisfaction to participate and help the parent movements—first for children with cerebral palsy, then for the mentally retarded, and lastly for the learning disabled" (Kirk, 1984, p. 41). When helping one group, he never abandoned the others as Danforth et al. implied. Kirk always believed in the educability and potential of all children and that all children were unique and deserving of the best instruction possible.Kirk (1962) maintained that one basic principle was inherent in the philosophy of a democracy, namely, that all children have the right to develop to their maximum potential. He commented that the expression "All men are created equal" denotes not only equality before the law, but also equality of opportunity. He summarized his view as follows:This, in fact, is the legacy that Dr. Samuel A. Kirk left behind, not just for the fields of learning disability and intellectual disability, but for all areas of disability.