What to do if you think a student you are teaching is Intellectually Disabled Intellectual Disability: Indicators and referral pathways

What is Intellectual Disability? The American Psychiatric Association (APA) diagnostic criteria for intellectual disability (DSM-5 criteria) has 3 parts: 1. Deficits in intellectual functioning 2. Deficits in Adaptive Functioning 3. Age of Onset

1. Deficits in intellectual functioning This includes various mental abilities: Reasoning; Problem solving; Planning; Abstract thinking; Judgment; Academic learning (ability to learn in school via traditional teaching methods); Experiential learning (the ability to learn through experience, trial and error, and observation). These mental abilities are measured by IQ tests. A score of approx. two standard deviations below average represents a significant cognitive deficit. These scores would occur about 2.5% of the population. Or, 97.5% of people of the same age and culture would score higher. The tests used to measure IQ must be standardized and culturally appropriate. (There are NO tests made BY or FOR Australian Aboriginal people)IQ tests

Normal distribution of intelligence Less than 2% of the population is expected to have an Intellectual Disability

2. Deficits or impairments in adaptive functioning This includes skills needed to live in an independent and responsible manner. Without these skills, a person needs additional supports to succeed at school, work, or independent life. Deficits in adaptive functioning are measured using standardized, culturally appropriate interview questionnaires (there are NO tests made BY or FOR Australian Aboriginal people). Various skills (adaptive behaviours/adaptive functioning) are needed for daily living: Communication: The ability to convey information from one person to another, through words and actions. It involves the ability to understand others, and to express one's self through words or actions. Social skills: The ability to interact effectively with others. These skills include the ability to understand and comply with social rules, customs, and standards of public behavior. This intricate function requires the ability to process figurative language and detect unspoken cues such as body language. Personal independence at home or in community settings: The ability to take care of yourself. Some examples are bathing, dressing, and feeding, the ability to safely complete day-to-day tasks without guidance eg cooking, cleaning, and laundry, and routine activities performed in the community like shopping for groceries, and accessing public transportation. School or work functioning: The ability to conform to the social standards at work or school. It includes the ability to learn new knowledge, skills, and abilities and apply this information in a practical, adaptive manner; without excessive direction or guidance. Difficulties must a) limit functioning in daily life and b) Occur across multiple environments (eg school AND home)

3. Age of Onset 3. These limitations occur during the developmental period. This means problems with intellectual or adaptive functioning were evident during childhood or adolescence. If these problems began after this developmental period, the correct diagnosis would be neurocognitive disorder. For instance, a traumatic brain injury from a car accident could cause similar symptoms.

What should I be looking for? Difficulties in school work are a POOR indicator, as there are SO many things that can cause this. Instead, look at adaptive functioning (how the student gets along in the world compared to their same aged peers). Physical skills (gross motor) Life skills (dressing, eating etc) Self direction and problems solving

If I am worried, what should I do? 1. Collect some data about the whole child (ID is NOT just difficulty with schooling – it is a global difficulty with all activities of daily life). 2. Meet with the parent and see if they share your concerns 3. Put in place a solid IEP and see if the problems resolve 4. Go through your school process for School Psychologist referral

School process The ratio of School Psychologists to Students in schools can be as much as 1:2000. So we don’t get to everyone. (We try, but…) The school is responsible for triaging all the requests and selecting the students with whom the School Psychologist will work. They have to choose those with whom assessment is most indicated, and intervention most likely to be effective (triage). THEN the assessment process can begin

Assessment process: (the WHOLE child) The first indication of ID is usually a child's physical and behavioral characteristics. Once an intellectual disability is suspected, formal assessment begins. The evaluation begins with a complete physical examination including hearing and vision assessment. Some medical conditions that cause temporary symptoms of ID can be treated effectively. Remember: Intellectual disabilities are defined by two major symptoms.two major symptoms 1. Limitations in intellectual functioning (mental abilities). 2. Limitations in adaptive functioning or life skills. A thorough assessment usually includes the following: comprehensive medical exam; (School Nurse screen, then referral to GP or Paediatrician) possible genetic and neurological testing; social and familial history; (parent interview) educational history; (parent and teacher interview) psychological testing to assess intellectual functioning; testing of adaptive functioning; (interviews with both parent and teacher, formal and culturally appropriate) social and behavioral observations of the child in natural environments At all stages differential diagnosis must be considered. Tammy Reynolds, B.A., C.E. Zupanick, Psy.D. & Mark Dombeck, Ph.D. from

How long will this take? ActivityTime Initial-pre-referral discussion with School SAER Co-ordinator or Student Services Team 0.5 hrs Case conference with Parent, Teachers, other agencies or staff. Discuss the learning needs and previous interventions, type of assessments proposed and possible risks/benefits. Get informed consent for assessment. 1.5 hrs Review of work samples and Teacher (curriculum based ) assessment 1.5 hrs Observations (typically in 2-3 sessions, for approx. 30 minutes each time) 1.5 hrs Interview with classroom Teacher (may include formal psychometric assessment interviews) 1.5 hrs Interview with parents (may include formal psychometric assessment interviews) 1.5 hrs Psychometric assessment with student (depending on the referral questions, this can be from 1-5 different assessments, each from 45 minutes to 1.5 hours) 1-6 hrs Score assessments and Interviews, conduct statistical analysis of results, consult with Senior Psychologists about findings 3 hrs Write report 4+ hrs Case conference to review assessments results, report and recommendations for intervention 1.5 hrs Review of interventions with Teacher and school SAER Co (4-10 weeks after report) 1.5 hrs Administration (Data collection and recording on statewide system, writing notes and exit letters etc) 1hr Approximate total per student 24 hrs

Differential diagnosis Why is the child having difficulty? Is it only explained by and Intellectual Disability OR could it be… Hearing/vision impairment making hard to understand what is going on in academic work? Poor attendance at school resulting in low academic achievement? A medical condition which can be treated? A mental health condition preventing the child from focusing on work (highly distressed state) Cultural or upbringing factors where the child has not yet been taught the “rules of the game of school”? Some thing else that we have missed?

Why are we doing this? The application of a diagnosis of ID must ONLY be undertaken for one reason: It will make the child’s life better We must begin this process with a clear plan for intervention (HOW we will make the child’s life better)– which we will follow whether or not they meet diagnostic criteria.

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