Pennsylvania Code › Title 55 - HUMAN SERVICES › Part VI - Mental Health/Intellectual Disability/Autism Manual › Subpart C - Administration and Fiscal Management › Chapter 4210 - DESCRIPTION OF SERVICES AND SERVICE AREAS › INTAKE PROCEDURES › Appendix A - TITLE IV-E INDEPENDENT LIVING (IL) PROGRAM GUIDELINES AND APPLICATION PROCESS

Current through Register Vol. 54, No. 28, July 13, 2024
The following information is quoted from the Diagnostic
						and Statistical Manual (DSM) IV:
"The essential feature of Mental Retardation is
						significantly subaverage general intellectual functioning (Criterion A) that is
						accompanied by significant limitations in adaptive functioning in at least two
						of the following skill areas: communication, self-care, home living,
						social/interpersonal skills, use of community resources, self-direction,
						functional academic skills, work, leisure, health, and safety (Criterion B).
						The onset must occur before age 18 years (Criterion C). Mental Retardation has
						many different etiologies and may be seen as a final common pathway of various
						pathological processes that affect the functioning of the central nervous
						system.
General intellectual functioning
is
						defined by the intelligence quotient (IQ or IQ-equivalent) obtained by
						assessment with one or more of the standardized, individually administered
						intelligence tests (e.g., Wechsler Intelligence Scales for Children-Revised,
						Stanford-Binet, Kaufman Assessment Battery for Children). Significantly
						subaverage intellectual functioning is defined as an IQ of about 70 or below
						(approximately 2 standard deviations below the mean). It should be noted that
						there is a measurement error of approximately 5 points in assessing IQ,
						although this may vary from instrument to instrument (e.g., Wechsler IQ of 70
						is considered to represent a range of 65-75). Thus, it is possible to diagnose
						Mental Retardation in individuals with IQs between 70 and 75 who exhibit
						significant deficits in adaptive behavior. Conversely, Mental Retardation would
						not be diagnosed in an individual with an IQ lower than 70 if there are no
						significant deficits or impairments in adaptive functioning. The choice of
						testing instruments and interpretation of results should take into account
						factors that may limit test performance (e.g., the individual's socio-cultural
						background, native language, and associated communicative, motor, and sensory
						handicaps). When there is significant scatter in the subtest scores, the
						profile of strengths and weaknesses, rather than the mathematically derived
						full-scale IQ, may more accurately reflect the person's learning abilities.
						When there is a marked discrepancy across verbal and performance scores,
						averaging to obtain a full-scale IQ can be misleading.
Impairments in adaptive functioning, rather than a low
						IQ, are usually the presenting symptoms in individuals with Mental Retardation.
Adaptive functioning
refers to how effectively individuals
						cope with common life demands and how well they meet the standards of personal
						independence expected of someone in their particular age group, socio-cultural
						background, and community setting. Adaptive functioning may be influenced by
						various factors, including education, motivation, personality characteristics,
						social and vocational opportunities, and the mental disorders and general
						medical conditions that may coexist with Mental Retardation. Problems in
						adaptation are more likely to improve with remedial efforts than is the
						cognitive IQ, which tends to remain a more stable attribute.
It is useful to gather evidence for deficits in adaptive
						functioning from one or more reliable independent sources (e.g., teacher
						evaluation and educational, developmental, and medical history). Several scales
						have also been designed to measure adaptive functioning or behavior (e.g., the
						Vineland Adaptive Behavior Scales and the American Association on Mental
						Retardation Adaptive Behavior Scale). These scales generally provide a clinical
						cutoff score that is a composite of performance in a number of adaptive skill
						domains. It should be noted that scores for certain individual domains are not
						included in some of these instruments and that individual domain scores may
						vary considerably in reliability. As in the assessment of intellectual
						functioning, consideration should be given to the suitability of the
						instruments to the person's socio-cultural background, education, associated
						handicaps, motivation, and cooperation. For instance, the presence of
						significant handicaps invalidates many adaptive scale norms. In addition,
						behaviors that would normally be considered maladaptive (e.g., dependency,
						passivity) may be evidence of good adaptation in the context of a particular
						individual's life (e.g., in some institutional
						settings)."1
1 Reprinted with permission
						from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition,
						Text Revision. Copyright 2000 American Psychiatric
						Association