Thursday, April 19, 2012

The Ins and Outs of Intellectual Disabilities

Monica over at The Undergrad Tales of a Psychology Major emailed me a fantastic group of questions that set me off and running in my (probably long-winded and unnecessarily detailed) response. She had some questions about intellectual disabilities, a topic that I find pretty cool. According to New York State, "intellectual disability" is defined as:
"...significantly subaverage general intellectual functioning, existing concurrently with deficits in adaptive behavior and manifested during the developmental period, that adversely affects a student's educational performance." [Part 200.1(zz7)]
If we're talking about the numbers and standard scores, a student with an intellectual disability (ID) generally has cognitive ability, academic achievement, and adaptive behavior at or below a standard score of 70. However, every child with ID looks totally different from every other one. Each has their own strengths, weaknesses, etc, and each needs to be educated in their own particular way to maximize their learning. When developing interventions for students with ID, you must go on a kid-by-kid basis. A good place to start is to modify assignments and instruction to what each child needs (i.e. fewer items, extra repetition, larger print, extra pictures/graphs, pre-taught vocabulary, re-taught material, manipulatives and hands-on learning, additional time to complete assignments, etc).

I looked through my cases over this year and found a few examples to send Monica, which I'll share here. Note that none of these five kiddos has exactly the same background, scores, profile, strengths, weaknesses, levels of services, or placement. That's why I find ID so fascinating!

For all the scores below, 90-109 is Average, with a 15 point standard deviation on either side. Also note that a classification of ID should not be taken lightly. The classifying psychologist and team need to conduct a thorough record review, social history, teacher interview, observations, medical exam, academic assessment, intellectual assessment, adaptive assessment, and in some cases, visual-motor, memory, projective, etc tests, if they so choose.

See this blog post for background information. After a very thorough evaluation, we classified this kiddo as a student with Multiple Disabilities due to pervasive delays, ID level cognitive ability, head trauma, and Fetal Alcohol Diagnosis. He was placed in a 6:1+1 Special Class for medically fragile students outside of our building. He receives occupational therapy (OT) and speech therapy, as well as services during the summer to prevent substantial regression.

Wechsler Preschool & Primary Scales of Intelligence, 3rd Ed. – Full Scale IQ (FSIQ) = 77
Bracken-3 Self Concept Scale – School Readiness = 77
Vineland Adaptive Behavior Composite = 74

Third Grader—
This kiddo was referred by her teachers in '10-'11 and had extensive interventions by a variety of school personnel. She was classified as a student with a Learning Disability and was placed in an Integrated Co-Teaching program (one gen ed teacher, one SPED teacher). We reevaluated her this year, and at that time, she was reading 26 words per minute (goal is 110 by end of 3rd) and was unable to recognize, identify, and count numbers to 100, let alone attempt addition and subtraction. She was academically very delayed, but was socially competent. She loved coming down for chats at lunch and was always giving hugs in the hallway. She was placed in a 15:1 Special Class outside of our building and her classification was changed to ID.

Wechsler Intelligence Scale for Children, 4th Ed. – FSIQ = 71
Woodcock-Johnson III Tests of Achievement – Broad Reading= 73; Broad Math= 79; Broad Written Language= 86

Fifth Grader—
This kiddo is currently in a 6:1+1 Special Class for students with intense behavioral and academic needs and is classified as a student with an Other Health Impairment. He has a diagnosis of ADD, for which he is not currently medicated, and he is uber distractible. He also displays symptoms of Autism (visual self-stimulation with small toys, perseverating on topics of interest, like TV shows). He has very limited social skills and often aggravates his more advanced classmates by violating their social boundaries to be friendly. He has no concept of social cues and is a big target for physical aggression--we have a safety plan for him so he doesn’t get killed by the boys in his class with Emotional Disturbances. Academically, he is at the first grade level or lower and reads 41 words per minute (goal is 115 by end of 5th). He is highly delayed both academically and socially. We are reevaluating him now and will be having his meeting at the end of the month. We have a placement saved for him for next year at a 12-month private school providing instruction in self-care and vocational skills to students with intellectual disabilities. His classification will be changed to ID.

Wechsler Abbreviated Scale of Intelligence, 2nd Ed. - FSIQ = 66
Woodcock-Johnson III Tests of Achievement – Brief Reading= 64; Brief Math= 54; Brief Written Language= 63
Vineland-II Adaptive Behavior Composite = TBD (I just finished testing him)

Fifth Grader—same classroom as above
This kiddo is also in a 6:1+1 classified as Learning Disabled. She has highly delayed daily living skills—can’t tie her shoes, has had bathroom accidents and not told anyone, can’t tell time or count coins, and has difficulty keep an orderly appearance that is socially appropriate (pulls her shirt and skirt up in class). She also tantrums in response to minor upsets and has very low frustration tolerance and coping skills. Her social skills are also impaired and she exhibits socially immature behaviors that hinder friendships. The kicker is that she’s a grade level reader at 118 words per minute and has passable writing skills, but her math is highly delayed. We reevaluated her and will be contacting the personnel in charge of the community-based life skills program within our district to evaluate her for their program.

Wechsler Intelligence Scale for Children, 4th Ed. – FSIQ = 60
Woodcock-Johnson III Tests of Achievement – Broad Reading= 85; Broad Math= 61; Broad Written Language= 89
Vineland-II Adaptive Behavior Composite = 62

Seventh Grader—
This kiddo was classified as a student with a Learning Disability and is currently placed within a 15:1 Special Class. Records indicated that she suffered a few strokes at birth due to ingesting meconium during delivery, but has not had any concerns past age four. On state exams in reading and math, she scored a Level 1, which does not meet basic standard. She cannot tell time or count coins, and has very basic skills in all academic areas. She is very immature socially and has difficulty working with others, but is an absolutely pleasant, sweet girl who is always smiling. We changed her classification to ID and she remains appropriately placed.

Wechsler Abbreviated Scale of Intelligence, 2nd Ed.- FSIQ = 62
Woodcock-Johnson III Tests of Achievement – Brief Reading= 83; Brief Math= 56; Brief Written Language= 71

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  1. Does your district recommend a second intellectual measure when suspecting an intellectual disability? (in Fl, we go by IND.. interesting... and it's considered best practice to administer two). Looking at these scores, it's very obvious these students need a significant level of support, however, in my county, not a single one of those children would be classified as IND except the first fifth grader you mentioned. Especially not the kindergartener with only a WPPSI and the rest of the scores higher.. however I bet the argument could be made for Other Health Impaired (OHI) served in an IND or Varying Exceptionalities (VE) classroom.

    In my district, scores have to be below 70 in all areas. If a student has a inconsistent profile, (maybe one iq sub 70, one above, adaptives mid 70s, academics scattered) they go before a disproportionality committee to determine if the child should be classified as IND.

    Honestly, it's so crazy now because they've moved to IND from the EMH, TMH, SPMH classifications, yet even then all of those students were mostly sub 70 iq on at least one assessment.

    What I think is actually pretty awesome is that there is such a wide variety of service in NY that can be provided to students with such diverse profiles. We're doing RtI (or trying, at least) and what's beginning to occur is that the majority of our 70s kids (flat profiles.. iq, achievement, adaptive) are qualifying for SLD because they're not responding to interventions sufficiently (or, the interventions required are unsustainable in the regular ed setting). All of this is very arbitrary of course, depending on your site, your kids, your admin, your staffing specialist, etc. Which is really not the best for the students much of the time! It's frustrating because in all honesty, would you expect a student with a 75 iq to progress at the same rate as a student with a 100 iq? Probably not, yet no one has seemed to research that fully yet... either way, I think there needs to be more done for those students who are in the 70s with some substantial strengths and weaknesses rather than tossing them in an SLD classroom (or giving them SLD pull-out resource services) with other children who are completely different from them. And it looks like your state does it! So please send some of those people our way lol. (end long-winded rant)

  2. As with Monica, most people in my neck of the woods do not start discussing ID until after IQ falls below 70, however, this year I have had many conversations about the ability of students who score very low cognitively being able to function in classrooms with students who are much higher than they are - pull out or not. I am fortunate enough to work in a district that offers many options to support the diverse caseload we have.

  3. In our district, we have one life-skills program where all scores must be in the 50s, but those students are often difficult to come by in a public school environment (and when I do come by them, I get totally angry that someone didn't find this get and get them placed for their needs sooner). Otherwise, we are able to service ID students in 15:1 classrooms, community based programs, or outside agency placements, depending on their level of need.

    Erika, I also struggle with those 70s standard score kids and that we need more to meet their diverse needs. When they're low functioning like that and don't respond to interventions, it's hard to tease out whether their LD or ID (though it seems like with your district's guidelines, it would be LD). We have students with those profiles in both Integrated Co-Teaching programs (as we do not have a Resource Room pull-out program in my building) or 15:1. However, kids like that are going to struggle once they get into HS and beyond, if they can make it that far given the fact that they've probably been retained a few times and are highly stressed academically due to their deficits. We have trouble with how to best serve them. I'm lucky in that my district does offer a variety of quasi-vocational programs for 15:1 level students, including theatre tech, hospitality, horticulture, automotive tech, etc. These programs often pair with businesses in the community like Wegmans to provide jobs after high school. It's hard to admit that 70s level kids may not be capable of college, but sometimes meeting them where they're at and teaching them something practical and useful is much more important.

  4. Thanks once again for all of your help! The students in my class really seemed to enjoy the real-life examples and I think it illustrated my "individual differences" point well. :)

  5. Quite glad to be of service!!


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