Current through Register Vol. 48, No. 9, September 27, 2024
A. Intellectual Developmental Disorder
Pursuant to the DSM-5, or most current edition, a diagnosis of
Intellectual Developmental Disorder requires consideration of both clinical
assessment and standardized testing of intellectual and adaptive functions.
Individual cognitive profiles based on neuropsychological testing as well as
cross-battery intellectual assessment using multiple IQ or cognitive tests to
create a profile will also be considered when making a determination of
eligibility. Specifically, an individual must meet the following three (3)
criteria in order to receive a diagnosis:
(1) Criterion A requires deficits in mental
abilities, referring to intellectual functions that involve reasoning, problem
solving, planning, abstract thinking, judgment, learning from instruction and
experience, and practical understanding.
To meet this criterion, individuals must have a valid IQ score
of approximately 70 or below, including a margin of measurement error of +/- 5,
establishing a range of eligibility from 65-75. Instruments must be normed for
the individual's sociocultural background and native language. When multiple
tests have been conducted for an individual, a clinical assessment of the
validity of the results and other related factors (i.e., statistically
significant splits between scores) of each singular test will occur as to
provide the appropriate clinical judgment of an individual's score.
(2) Criterion B requires
impairment in everyday adaptive functioning, in comparison to an individual's
age, gender, and socioculturally matched peers.
To meet this criterion, individuals must have one domain in
adaptive functioning-conceptual, social, or practical-sufficiently impaired as
to necessitate ongoing support in order to have the individual perform
adequately at school, at work, at home, or in the community. For the purposes
of this Criterion B, the conceptual (academic) domain involves competence in
memory, language, reading, writing, math reasoning, acquisition of practical
knowledge, problem solving, and judgment in novel situations, among others. The
social domain involves awareness of others' thoughts, feelings, and
experiences; empathy; interpersonal communication skills; friendship abilities;
and social judgment, among others. The practical domain involves learning and
self-management across life settings, including personal care, job
responsibilities; money management, recreation, self-management of behavior,
and school and work task organization, among others.
Adaptive functioning is evaluated by using both clinical
evaluation and individualized, culturally appropriate, psychometrically sound
measures. Standardized measures are used with knowledgeable informants (e.g.,
parent or other family members; teacher; counselor; care provider) and the
individual to the extent possible. Additional sources of information include
educational, developmental, medical and mental health evaluations. In
situations where standardized testing is difficult or impossible (e.g., sensory
impairment, severe problem behavior), the individual may be diagnosed with
unspecified intellectual development disorder. Intellectual capacity,
education, motivation, socialization, personality features, vocational
opportunity, cultural experience, and coexisting other medical conditions or
mental disorders influence adaptive functioning.
(3) Criterion C requires onset to occur
during the developmental period, referring to recognition of intellectual and
adaptive deficits being present in childhood or adolescence.
To meet this criterion, a comprehensive evaluation is required.
A comprehensive evaluation includes an assessment of intellectual capacity and
adaptive functioning; identification of genetic and non-genetic etiologies;
evaluation for associated medical conditions (e.g., cerebral palsy, seizure
disorder); and evaluation for cooccurring mental, emotional, and behavioral
disorders. Components of the evaluation may include basic pre-and perinatal
medical history, three-generational family pedigree, physical examination,
genetic evaluation, and metabolic screening and neuroimaging assessment.
B. Related Disability
(1) Diagnosis of Related Disability requires
all four (4) of the following conditions:
(a)
It is attributable to cerebral palsy, epilepsy, or any other condition other
than mental illness found to be closely related (i.e., empirical medical
evidence) to Intellectual Disability because this condition results in
impairment of general intellectual functioning or adaptive behavior similar to
that of persons with Intellectual Disability and requires treatment or services
similar to those required for these persons; and
(b) It is likely to continue indefinitely;
and,
(c) It results in substantial
functional limitations in three (3) or more of the following areas of major
life activity: Self-care, Understanding and Use of Language, Learning,
Mobility, Self-direction, Capacity for Independent Living; and
(d) The onset is before age 22
years.
(2) Only scores
derived from nationally normed standardized tests administered by qualified
examiners shall be used in eligibility determinations. Substantial functional
limitations shall be defined as the results from administration of a
standardized, norm-referenced test yielding a score of two standard deviations
or more below the mean.
C. High-Risk Infant/At Risk Child
(1) Diagnosis of High Risk Infant/At Risk
Child requires that a child younger than 72 months of age meet one of the
following:
(a) Exhibits significant documented
delays in three or more areas of development; or
(b) Have a diagnosis, as recognized by the
Individuals with Disabilities Education Act (IDEA) Part C program (BabyNet)
Established Risk Condition List, confirmed by a medical professional and
exhibit significant documented delays in two areas of development.
D. Autism Spectrum
Disorder
(1) Diagnosis of ASD based on the
(DSM-5) requires that the results from a battery of ASD specific assessments
confirm:
(a) Persistent deficits in social
communication and social interaction across multiple contexts, as manifested by
the following three (3) criteria, currently or by history:
(i) Deficits in social-emotional reciprocity,
ranging, for example, from abnormal social approach and failure of normal
back-and-forth conversation; to reduced sharing of interests, emotions, or
affect; to failure to initiate or respond to social interactions.
(ii) Deficits in nonverbal communicative
behaviors used for social interaction, ranging for example, from poorly
integrated verbal and nonverbal communication; to abnormalities in eye contact
and body language or deficits in understanding and use of gestures; to a total
lack of facial expressions and nonverbal communication.
(iii) Deficits in developing, maintaining,
and understanding relationships, ranging, for example, from difficulties
adjusting behavior to suit various social contexts; to difficulties in sharing
imaginative play or in making friends; to absence of interest in
peers.
(2)
Restricted, repetitive patterns of behavior, interests, or activities, as
manifested by at least two of the following, currently or by history:
(a) Stereo-typed or repetitive motor
movements, use of objects, or speech (e.g., simple motor stereotypes, lining up
toys or flipping objects, echolalia, idiosyncratic phrases).
(b) Insistence on sameness, inflexible
adherence to routines, or ritualized patterns of verbal or nonverbal behavior
(e.g., extreme distress at small changes, difficulties with transitions, rigid
thinking patterns, greeting rituals, need to take same route or eat same food
every day).
(c) Highly restricted,
fixated interests that are abnormal in intensity or focus (e.g., strong
attachment to or preoccupation with unusual objects, excessively circumscribed
or perseverative interests).
(d)
Hyper- or hypo-reactivity to sensory input or unusual interest in sensory
aspects of the environment (e.g., apparent indifference to pain/temperature,
adverse response to specific sounds or textures, excessive smelling or touching
of objects, visual fascination with lights or movement).
(3) Symptoms are present in the early
developmental period (but may not become fully manifest until social demands
exceed limited capacities, or may be masked by learned strategies in later
life).
(4) Symptoms cause
clinically significant impairment in social, occupational, or other important
areas of current functioning.
(5)
These disturbances are not better explained by Intellectual Disability
(Intellectual Developmental Disorder) or global developmental delay.
Intellectual Disability and Autism Spectrum Disorder frequently cooccur; to
make comorbid diagnoses of Autism Spectrum Disorder and Intellectual
Disability, social communication should be below that expected for general
developmental level.
E.
Head and Spinal Cord Injury and Similar Disability
(1) Diagnosis of Head or Spinal Cord Injury
or Similar Disability requires:
(a) Medical
documentation and functional/adaptive assessments to substantiate that
Traumatic Brain Injury, Spinal Cord Injury or Similar Disability occurred and
produced ongoing substantial functional limitations. Including documentation of
pre-existing/concurrent conditions, which impact functioning.
(b) The person has a severe chronic
limitation that:
(i) Is attributed to a
physical impairment, including head injury, spinal cord injury or both, or a
similar disability, regardless of the age of onset, but not associated with the
process of a progressive degenerative illness or disease, dementia, or a
neurological disorder related to aging;
(ii) Is likely to continue indefinitely
without intervention;
(iii) Results
in substantial functional limitation in at least two (2) of these life
activities: Cognitive; Self-care; Communication; Learning; Mobility;
Self-direction; Capacity for independent living; Economic self-sufficiency;
and,
(iv) Reflects the person's
need for a combination and sequence of special interdisciplinary or generic
care or treatment or other services, which are of lifelong or extended
duration.
