Intellectual Disability Assessment Research Articles

Autism Severity and its Relationship to Disability.

Autism severity is currently defined and measured based exclusively on the severity levels of the two core symptom domains: social-communication and restricted or repetitive patterns of behaviors and interests. Autistic individuals, however, are often diagnosed with other medical, developmental, and psychological co-occurring conditions. These additional challenges such as intellectual disability, limited expressive and/or receptive language, and anxiety disorders, can have a tremendous impact on the day-to-day lives of autistic individuals, for both their adaptive functioning as well as their sense of wellbeing. Furthermore, the initial presentation of core symptoms and their likelihood of changing over time are influenced by the presence of such co-occurring conditions. In order to truly understand how a person's autism impacts their life, both core symptoms as well as other challenges should be considered. This approach was recently taken by The Lancet Commission on the future of care and clinical research in autism, which proposed the term "profound autism" for a subgroup of individuals presenting with high core symptom severity, co-occurring intellectual disability, and little or no language, who require extensive long-term care. Considering other individual factors such as daily living skills, specific support needs and environmental resources would also enhance the evaluation of disability in autistic individuals. As currently employed in the assessment of intellectual disability, a multidimensional approach to autism could provide a more comprehensive system for classification of impairment. At present, however, there is no formal way to designate the combined effect of these different aspects of autism on a person's life. A comprehensive outlook that acknowledges impairments, capabilities, co-occurring conditions, and environmental factors would be useful for identifying subgroups of individuals as well as for determining individual needs and strengths in clinical assessments. Lay Summary: The severity of a person's autism is currently defined based on the severity of their core autism symptoms: impaired social-communication and the presence of restricted or repetitive patterns of behaviors and interests. But autistic people often face additional challenges such as intellectual disability, epilepsy, and anxiety disorder, that considerably impact their everyday life, wellbeing, and the need for support. A more complete view of autism severity, one that includes core symptoms as well as additional challenges, could help identify meaningful sub-groups of autistic individuals and could be useful in clinical care. Appeared originally in Autism Res 2023; 16:685-696.

Autism severity and its relationship to disability.

Autism severity is currently defined and measured based exclusively on the severity levels of the two core symptom domains: social-communication and restricted or repetitive patterns of behaviors and interests. Autistic individuals, however, are often diagnosed with other medical, developmental, and psychological co-occurring conditions. These additional challenges such as intellectual disability, limited expressive and/or receptive language, and anxiety disorders, can have a tremendous impact on the day-to-day lives of autistic individuals, for both their adaptive functioning as well as their sense of wellbeing. Furthermore, the initial presentation of core symptoms and their likelihood of changing over time are influenced by the presence of such co-occurring conditions. In order to truly understand how a person's autism impacts their life, both core symptoms as well as other challenges should be considered. This approach was recently taken byThe Lancet Commission on the future of care and clinical research in autism, which proposed the term "profound autism" for a subgroup of individuals presenting with high core symptom severity, co-occurring intellectual disability, and little or no language, who require extensive long-term care. Considering other individual factors such as daily living skills, specific support needs and environmental resources would also enhance the evaluation of disability in autistic individuals. As currently employed in the assessment of intellectual disability, a multidimensional approach to autism could provide a more comprehensive system for classification of impairment. At present, however, there is no formal way to designate the combined effect of these different aspects of autism on a person's life. A comprehensive outlook that acknowledges impairments, capabilities, co-occurring conditions, and environmental factors would be useful for identifying subgroups of individuals as well as for determining individual needs and strengths in clinical assessments.

A STOMP-focused evaluation of prescribing practices in one assessment and treatment unit for people with intellectual disabilities

PurposeThis study aims to understand whether psychotropic prescribing practices for people with intellectual disabilities are in keeping with best practice guidelines.Design/methodology/approachThis service evaluation project was a retrospective analysis of routinely collected data from the care records of all 36 people with intellectual disability discharged from an intellectual disability assessment and treatment unit during the first five years of the Stop Over medicating People with Intellectual Disabilities and/or autistic people (STOMP) initiative. Data were gathered at four time points (pre-admission, discharge, 6- and 12-month follow-up) before being analysed to understand whether psychotropic prescribing differed among people with different clinical characteristics/traits/diagnoses. Changes over time were also explored to ascertain whether and how prescribing altered from admission to discharge, and over the subsequent year of community living.FindingsMost people with intellectual disabilities left the assessment and treatment unit on fewer regular psychotropic medications and at lower doses than at admission. These optimised regimes were still apparent 12 months post-discharge, suggesting effective discharge planning and community care packages. Inpatients with severe intellectual disabilities generally received more anxiolytics and hypnotics, at higher doses. Autistic people tended to receive more psychotropics in total and at higher cumulative doses, a pattern that persisted post discharge. A third of the sample were admitted on regular anti-psychotic medications despite having no corresponding psychotic diagnosis, a proportion that remained relatively stable through discharge and into the community.Originality/valueThis study highlights subsets of the intellectual disability population at particular risk of receiving high doses of psychotropics and a feasible template for providers intending to undertake STOMP-focused evaluations.

Learning in the shadow of eugenics: Why segregated schooling persists in Australia

Inclusive education is a global priority and binding obligation for Australia to meet as a signatory to international human rights treaties. It is also supported by evidence as an effective model of schooling for all students and supporting those with disability. Yet segregation remains deeply embedded within the education systems of all states and territories and the Australian Government has indicated its commitment to retaining it. In this article, I present a policy analysis using the concept of path dependency to identify historical events that created this dual track of segregated and regular education settings as well as the mechanisms that maintain it. I show that eugenic anxieties were fundamental in the formalised creation of segregated education settings. I also show that their expansion was fuelled by the rise of disability assessments, particularly the assessment of intellectual disability, and remain embedded in current policy even when they are antithetical to its goals. I conclude with suggestions for how this might be overcome and what it might take to achieve an inclusive education system in Australia.

Assessment of Intellectual Disability With the Wechsler Intelligence Scale for Children, Fifth Edition: Analysis of Part Score Profiles and Diagnostic Outcomes

This study examined the group and individual part score profiles of individuals with mild intellectual disability (ID) who participated in a clinical validity study supporting the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V) and a comparison group without ID derived from the WISC-V norming sample. Descriptive analyses revealed that both groups exhibited flat profiles of part scores (i.e., the five WISC-V factor indexes), with mean global composites and part scores in the Very Low range for the ID group and in the Average range for the comparison group. However, few participants in either group exhibited profiles similar to their respective group profile, and many in both groups exhibited substantial profile scatter. Examination of global composites and part scores obtained by individuals with ID revealed that the WISC-V’s global composites consistently identified those with ID using score thresholds of 70 to 75, but many individuals with ID obtained part scores much higher than this criterion. No meaningful differences were found between Black and White participants with ID. Implications focus on the risks associated with using part score elevation or profile scatter to defer identification of ID when all other criteria for the condition have been met. Impact Statement Because the cognitive profile of those with intellectual disability (ID) is generally low and flat, indicating a deficit in overall intellectual functioning with little variation among part scores, many presume that individuals with this disorder will exhibit the same pattern. Although most individuals with ID exhibit a low IQ consistent with the disorder, many exhibit much higher part scores, and significant part score scatter is common in individuals with ID. Failure to identify individuals with ID due to part score elevation or to significant profile scatter will likely have unintended negative consequences.

Assessment of intellectual disability in Klinefelter’s Syndrome associated with other Prenatal and Perinatal risk factors. A case report

IntroductionKlinefelter’s syndrome (KS) is considered as a genetic risk factor for intellectual disability and specifically for impairment on verbal skills. Prenatal and perinatal morbidity concurrent with this diagnosis determine the entity and typology of neurodevelopmental deficits.ObjectivesTo describe the intellectual and adaptive functioning of a patient with KS and prenatal and perinatal difficulties, assessed in the Service of Psychiatry, Clinical Psychology and Mental Health at La Paz University Hospital (Madrid).MethodsA descriptive study was conducted of a 6 year and 7-month-old boy with diagnosis of KS (karyotype XXY), extremely low weight at birth (752 gr.), Arnold Chiari type I malformation with post-hemorrhagic hydrocephalus and periventricular leukomalacia, bronchopulmonary dysplasia, intra-atrial septal defect, left kidney agenesis with iatrogenic adrenal insufficiency, and acute ventriculitis due to E. Coli. Neuropsychological evaluation was carried out in October 2021. Leiter-3 scale was selected due to the absence of expressive language; and his parents completed the questionnaire Adaptive Behavior Assessment System-II.ResultsThe nonverbal intelligence quotient was observed in the very low range (full-scale IQ = 69). The result of general adaptive behavior (z = -2.83), showed very high functional disability both in the conceptual, social, and practical domains.ConclusionsThe high number of causes of disability in this patient is consistent with a high degree of functional disability. Efficient evaluation sessions of intellectual performance, adaptive functioning, and necessary supports, due to the absence of expressive language and limited receptive language, are required. A specific neuropsychological evaluation profile should be established for KS.DisclosureNo significant relationships.

Bladder and bowel dysfunction, adaptive behaviour and psychiatric profiles in adults affected by autism spectrum disorders.

Bladder and bowel dysfunction (BBD) have been recognized in children affected by autism spectrum disorder (ASD), but no consistent information existin adults with the condition. We evaluated the prevalence of BBD and the impact of psychiatric and behavioural profiles in adults affected by ASD. Twenty-two adults and 13 children/teens with ASD and a matched group of typically developing subjects (TD) were prospectively studied. Patients and TD subjects underwent the evaluation of urinary incontinence (UI: diurnal, continuous or intermittent), nocturnal enuresis (NE), and bowel disturbances with the 3-day voiding and bowel diary. In addition, assessment of intellectual disability (ID) and psychiatric and adaptive behaviours with the Neuropsychiatric Inventory Scale (NPI) and the Vineland Adaptive Behaviour Scale 2nd Edition (Vineland-II), was performed. In adults, any type of incontinence was observed in 81.8% of cases, and NE and intermittent UI in 59.0% and 36.3% of patients, respectively. Faecal incontinence and constipation were detected 36.3% and in 68.1% of cases, respectively. ID was severe in 2 cases and profound in 18; NPI and Vineland-II items most affected were "Irritability/Lability," "Motor Activity," and "Agitation," and IQ-Socialization and IQ-Communication. Significant relationships were identified between intermittent UI and greater ID (P < .02) and high "anxiety" (P < .05), and between NE and high "euphoria/elevated mood" (P < .05). These results were similar to those observed in children/teens. Adults with ASD, and greater ID and mood disorders, present with a high prevalence of BBD. A shared pathogenetic mechanism could underlie the co-occurrence of ASD, mood disorders, and BBD.

The reliability and validity of the Adaptive Functioning Assessment Tool in UK custodial settings.

Adaptive functioning (AF) has been overlooked in the assessment of intellectual disability within the UK Prison Service, primarily because there are no reliable and valid measures of AF suitable for use with prison populations. This position is incompatible with the obligation of Her Majesty's Prison and Probation Service to provide specialist interventions for individuals with intellectual disabilities. This study assessed the psychometric properties of the Adaptive Functioning Assessment Tool (AFAT), a new measure of AF developed for use in prisons. The AFAT was completed on 61 participants (mean age 41, standard deviation 11.8). Internal consistency was tested using Cronbach's α. Construct validity was assessed using linear regression and a Receiver Operator Characteristic analysis. The findings provide evidence to support the AFAT being a reliable and valid measure of AF in prison populations.

The assessment of intellectual disability: ‘Looking at your assessments we think you have an intellectual disability’ – What does this mean?

This article describes the development of an informative booklet designed to provide information and support to individuals recently assessed and told that they have an intellectual disability. The booklet uses the term ‘learning disability’ as this terminology is more widely used within the Rotherham, Doncaster and South Humberside NHS Foundation Trust. However, the text within this article tends to refer to ‘intellectual disability’ as this is consistent with the term used by the FPID Bulletin.

‘Matched Care’: An audit of the psychological demand and activity in an Intellectual Disability Assessment and Treatment Unit

‘Matched Care’: An audit of the psychological demand and activity in an Intellectual Disability Assessment and Treatment Unit

Intellectual Disability Assessment: Anomalous Picture Concepts Scores in WISC-IV

Attention is drawn to a putative WISC anomaly, specific to the case of Intellectual Disability (ID) IQ assessment. With ID, at best the WISC-IV Picture Concepts (PCn) is not a consistent part of the underlying “ability” represented by Perceptual Reasoning Index (PRI) factor, while at worst the PCn score may be “wrong”. This worst case situation is marked by a “very high PCn score” in an otherwise low profile and this outcome awaits a better interpretation which would be meaningful to the target child with Intellectual Disability. The literature relating to PCn scores in cases of “intellectually different” cohorts shows conflicting published evidence that the sub-test may be either generally lower than the cohort average, or generally above that average, for example in cases of Autism. The present paper proposes that the broad explanation for the PCn anomaly is explained by deriving an answer to each item from a focus on single-feature solution rather than an integrative approach. Future research may clarify the frequency and the meaning of this issue, while the present paper raises a caution in the “standard” interpretation of intellectual disability IQ profiles.

IQ Scores Should Be Corrected for the Flynn Effect in High-Stakes Decisions

IQ test scores should be corrected for high stakes decisions that employ these assessments, including capital offense cases. If scores are not corrected, then diagnostic standards must change with each generation. Arguments against corrections, based on standards of practice, information present and absent in test manuals, and related issues, ignore expert consensus about the assessment of intellectual disabilities and the acceptance of the Flynn effect in the field. Most psychometric concerns about correction are based on validity studies with small subgroups and do not reflect sufficient effort to estimate the precision of the Flynn estimate. We computed a confidence interval for the Wechsler PIQ across four validity studies that shows a SEM of about 1 around a mean of about 3 points per decade. A meta-analytic weighted mean of the 14 studies in Flynn (2009) is 2.80 (2.50, 3.09), close to Flynn’s (2009) unweighted average (2.99). More psychometric research would be helpful, but this level of precision supports the Flynn adjustment of 3 points per decade.

Forensic issues in intellectual disability

The present paper reviews some of the most significant findings in the field of forensic issues related to intellectual disability over the last 2 years. Recent publications have explored the prevalence and assessment of intellectual disabilities in the criminal justice system, as well as individual characteristics of intellectual disabled offenders. Service by the criminal justice system and treatment of intellectual disabled offenders have also been explored. New insights into violence and sexual offences have been achieved, however identification and evidence-based treatment of intellectual disabled offenders are not widely explored issues. Progress in treatment studies, studies of the function of the criminal justice system and risk assessments have resulted in improvements in these aspects during recent years. The wide range of services involved in successful initiatives has been addressed, but some crucial aspects still receive too little attention. Differences between countries and cultures have not been emphasized, and the progress that has been achieved seems to be confined to countries with a clear policy and organized services for offenders with intellectual disabilities.

Applying cognitive malingering screening test in the intellectual disability assessment

目的 探讨认知伪装甄别测验在智力残疾评定中的应用价值.方法 在接受智力残疾评定者中选择具有伪装倾向者57例,以同期接受智残评定的非伪装者55例作对照,分别进行韦氏成人智力测验及认知伪装甄别测验.结果 伪装组在韦氏智力测验的语言智商数、操作智商数、总智商数均低于非伪装组但差异未达到显著性水平t值分别为0.162,0.931,0.603,均P ＞0.05.伪装组在认知甄别测验的各条目上的均分均接近或低于机遇水平,与非伪装组相比差异非常显著,其中数字迫选总分、容易条目分、中等难度条目分、困难条目分t值分别为4.587,4.440,3.069,2.603,均P ＜0.01.图符迫选总分、容易条目分、中等难度条目及困难条目分t值分别为4.690,3.226,4.215,3.216 ,均P ＜0.01.相关分析显示伪装组的韦氏智力测验与认知甄别测验的相关性明显低于对照组.结论 认知伪装甄别测验在一定程度上可以反映被试者韦氏智测成绩的真实程度,在智力残疾等级的评定中具有一定的应用价值。

An assessment of intellectual disability among Aboriginal Australians

The health and well-being of Indigenous people is a significant global problem, and Aboriginal Australians suffer from a considerably higher burden of disease and lower life expectancy than the non-Indigenous population. Intellectual disability (ID) can further compromise health, but there is little information that documents the prevalence of ID among indigenous populations. This study provides information on ID among the Aboriginal population of Western Australia. The Disability Services Commission (DSC) of Western Australia has maintained a statewide database of people with ID since 1953. Data on people of Aboriginal descent were extracted from the DSC database and linked to two other state-based databases, the Hospital Morbidity Data System and the Deaths Registry, with additional linkage to the National Death Index. The linked data were used to assess the prevalence, survival patterns and causes of death in Aboriginal people with ID. Although comprising 3.5% of the population, Aboriginal Australians represented 7.4% of all people registered for ID services. The level of ID was assessed as borderline or mild in 40.7% of cases, moderate in 19.9%, severe or profound in 12.1%, but had not been specified in 27.2% cases. Median survival was 55.1 years for men and 64.0 years for women, with a mean age at death (n = 102) of 19.6 years. The leading causes of death were respiratory diseases, diseases of the circulatory system, and accidents. The study presents unique population summary data for ID in the Aboriginal community of Western Australia. To provide appropriate prevention and intervention strategies, there is an urgent need for more detailed information on the prevalence and patterns of ID.