Tag Archives: Intellectual Disability

Alternative Counselor Roles

The role of the “advocate” is one I believe counselors are naturally aligned to, and should consider.  One example where I currently serve as an advocate is vocational training for intellectually challenged adults.  The reality is that most of us, on or about the age of 16, were able to get a hiring manager to “take a shot in the dark” and hire us with no experience.  The unfortunately truth is that isn’t the case for the developmentally disabled or the intellectually challenged population, thereby necessitating the need for “transition placement” and subsequent advocacy on the behalf of that population.

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Understandably, the business establishment has good reason to be weary of something it does not fully understand… I think that is part of human nature and cannot be faulted to a certain degree.  Every hiring manager should have the reassurance that someone is capable of fulfilling their duties as an employee, and it’s not entirely unreasonable to ask the question of someone who is intellectually challenged (after all, they would ask it of a “normal” applicant).  Vocational training gives people with developmental disabilities the opportunity to prove themselves, and the opportunity to demonstrate that they “have valuable skills” and can make a “lasting contribution to a business.”

For example, I currently work with an individual who only 8 years ago was “pigeon-holed” by the developmental model.  It was assumed that this particular individual would never grow “beyond the capacity of a child” and, as a result, he was largely treated as a child.  Through a rigorous process of cognitive, social and skills training… he has become “one of the most productive people on the line” at a local business.  I recently spoke with his employer, and he “regrets even hesitating to pick him up, as he now considers him among the most competent employees he has.”   Granted, the work is pretty basic, but this particular individual is fiercely loyal, driven to succeed, and competent at most basic assembly tasks.  That kind of independence would not have been possible without our advocacy.

Despite the fact that I am not yet a full time paid therapist, I can play the advocate role today.  Even now, I have clients who are consistently told by family and friends that “they will never be able to do that.”  I endeavor to break as many of those molds as is possible, as I believe in the general premise put forth by Dr. Marc Gold:  “The behaviors our children show are a reflection of our incompetence, not theirs.”  With regard to the training I would need to fulfill that role, I believe it is already underway.  I would be better able to advocate for an individual as a therapist, because I could bring the weight of a DSM-IV diagnosis to bear, and speak with knowledge about “what’s typical” and “what’s realistic” for a specific individual.  I believe the role as an advocate, especially for people whom are intellectually challenged, is key role we as counselors can play in their development of cognitive, social, skills based functioning.

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Definition of Intellectual Disability

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What two (2) major elements are necessary for a diagnosis of mental retardation?

Intellectual disability is a disability characterized by significant limitations both in (1) intellectual functioning and in (2) adaptive behavior, which covers many everyday social and practical skills.  (American Association on Intellectual and Developmental Disabilities [AAIDD], 2010 , para. 1)

What are the limitations of this definition?

The first and most objective limitation is the age of onset.  This disability originates before the age of 18.   (AAIDD, 2010 , para. 1)

A second quasi-objective limitation to a diagnosis of mental retardation is intelligence quotient (IQ).  One criterion to measure intellectual functioning is an IQ test.  Generally, an IQ test score of around 70 or as high as 75 indicates a limitation in intellectual functioning.  (AAIDD, 2010 , para. 3)

A third, more subjective measure, is the degree to which a disability limits adaptive behavior.  Standardized tests can be used to gain objectivity in the areas of conceptual, social, and practical skills.

Fourth and finally, the AAIDD takes qualitative differences in environmental, cultural, socioeconomic, and other normative factors (language) into consideration.  They acknowledge that limitations often coexist with strengths, and that outcomes can be positive with sustained personalized supports.

How does this definition compare to the DSM-IV TR?

The DSM-IV-TR criterion(s) for a mental retardation diagnosis are as follows… (American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 2000, p. 41)

A)    Significantly sub-average general intellectual functioning accompanied by;

B)    Significant limitations in adaptive functioning in at least two of the following skill areas:

  1. Communication
  2. Self-Care
  3. Home Living
  4. Social/Interpersonal Skills
  5. Use of Community Resources
  6. Self-Direction
  7. Functional Academic Skills
  8. Work
  9. Leisure
  10. Heath
  11. Safety

C)    The onset must occur before age 18.

The DSM authors make more formal recommendations on which IQ tests should be used to measure IQ and acknowledge differences of measurement between them.  They share commonality with the AAIDD definition in the regard to the arbitrary IQ cutoff (approximately 70-75 or below).  The DSM also shares concern with AAIDD in that they “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). (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000, p. 42)  Like the AAIDD, the DSM posits a dimensional assessment of strengths and weaknesses when the nature of the disability skews IQ scores.

Although I think the variance in severity is implied by the AAIDD, the DSM authors codified the broad differences between individuals with mental retardation.  On the whole, my impression is that the AAIDD definition was written and based on the DSM-IV-TR.

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American Association on Intellectual and Developmental Disabilities. (2010 ). Definition of intellectual disability. Retrieved March 26, 2010, from http://www.aamr.org/content_100.cfm?navID=21

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.