Handbook of Assessment in Persons with Intellectual Disability Eciiiodby Johnny L. Matson International Review of RESEARCH IN MENTAL RETARDATION Handbook of Assessment in Persons with Intellectual Disability VOLUME 34 ST. MARY'S CITY, MARYLAND Board of Associate Editors Philip Davidson UNIVERSITY OF ROCHESTER SCHOOL OF MEDICINE AN! Elisabeth Dykens VANDERBILT UNIVERSITY Michael Guralnick UNIVERSITY OF WASHINGTON Richard Hastings UNIVERSITY OF WALES, BANGOR Linda Hickson COLUMBIA UNIVERSITY Connie Kasari UNIVERSITY OF CALIFORNIA, LOS ANGELES William Mcllvane E.K. SHRIVER CENTER Glynis Murphy LANCASTER UNIVERSITY Ted Nettelbeck ADELAIDE UNIVERSITY Marsha M. Seltzer UNIVERSITY OF WISCONSIN-MADISON Jan Wallander SOCIOMETRICS CORPORATION VOLUME 34 EDITED BY Johnny L. Matson LOUISIANA STATE UNIVERSITY DEPARTMENT OF PSYCHOLOGY BATON ROUGE, LOUISIANA ELSEVIER AMSTERDAM • BOSTON • HEIDELBERG • LOND< NEW YORK • OXFORD • PARIS • SAN DIEGO SAN FRANCISCO • SINGAPORE • SYDNEY • TOK Academic Press is an imprint of Elsevier SCHIEFELBUSCH INSTITUTE FOR LIFE SPAN STUDIES, THE 1 OF KANSAS, LAWRENCE, KANSAS R. MATTHEW REESE DEVELOPMENTAL DISABILITIES CENTER, THE UNIVERSITY MEDICAL CENTER, KANSAS CITY, KANSAS I. INTRODUCTION The history of the assessment of people with intellectual < like the unfolding of an evolutionary tree. It goes back to th( day research and practice as well as to the roots of many socia cases, it has been a life-and-death matter, as in the Suprei Atkins v. Virginia (2002), which ruled against capital punis with ID. This controversial case continues, however (Perske, opment of IQ tests grew out of the need in the early 1900s to di with ID, in order to predict school success better. Out of thi; new definition of intelligence, the idea of general intelligence ( concept of intelligence consisting of several primary abilities. IQ tests were also misused to set immigration quotas for alities, to justify the eugenics movement, and to promote ste these abuses grew the need in the 1930s and 1940s to assess a skills, in order to broaden the concept of intelligence of p reflect its social aspects more accurately. As the awakening of the community and personal emp ments emerged in the 1950s, the need to assess personalit psychopathology, and behavior problems, which were imp< pendence and community integration, became more iim; carefully. INTERNATIONAL REVIEW OF RESEARCH IN MENTAL RETARDATION, Vol. 34 0074-7750/07 $35.00 1 ( DOI: 10. purposes 01 entitlement ^iviaciviinan, oresnam, cl vipersu than as a prescription for programming. The 2002 revision ( 2002) reduced the areas of life-functioning supports needed i a new "supports intensity scale" has been developed (Thorn; to assess them. As federal entitlements to services for people with ID grev standardized measures on work performance, social skills, opment, quality of life (QOL), family adaptation, psych< efficacy of psychopharmacology developed in the latter half century. At first, these measures were an extension of insti dized on the nondisabled population; but, as the research became clear that tests standardized on specialized subpop were the most valid and reliable. Another movement which greatly affected assessment ID during this period was the advancement of the field of; analysis (ABA) in the 1960s. As an alternative to psyc referenced tests, ABA assessment relied totally on in vivo f ment in the context of the target environment, identify consequences that influenced behaviors, and modifying thei Wolf, & Risley, 1968). Single-subject designs were espoi group designs. Functional assessments were later standa Iwata, Dorsey, Slifer, Bauman, and Richman (1982) by col standard analogue setting, using standard stimuli and reinfc gencies, to analyze and predict what would work in the in vh technique called functional analysis (FA) and its variants h popular in the last 24 years in the United States, especiall behavior problems of people with ID. Matson in his handbook Assessing the Mentally Retai Bruening, 1983) was one of the first to address the assessmei as a field in itself. As the current volume shows, this field he dously in the last 23 years into a more mature discipline with specialized assessment instruments available for research an have superceded their earlier progenitors. There really is no e: years ago ^.oerKson, zulh-;. loosen, ^iarK, ana jsjviiz ^iy/c best general recent histories of ID from the Greeks up to concepts of people with ID varied from subjects of scorn to viewing them as fools in the middle ages. Luther and Calvin as "filled with Satan." Some of these attitudes still persis third-world countries people with ID are still seen as a j God, and they are kept in seclusion. Assessment of people with ID did not become an issue un century when humanitarian institutions and training springing up. From descriptions of the living conditions ( Massachusetts by Dix (1843), it is apparent that little disti between the mentally ill, criminals, the poor, and people wii to be segregated from society. Being labeled as "mentally < small matter to an individual. The first systematic descriptions of people with ID as a sej in need of training were by Itard in 1838 and Seguin in 1842 (E Training schools followed quickly in Europe and in the Uni Seguin moved to the United States, these institutions quic Massachusetts, Ohio, Connecticut, Pennsylvania, Kentucky, Minnesota, Indiana, California, Michigan, and Nebraska b Itard and Seguin, physicians ran all of these facilities. They w psychological or behavioral assessment methodology. They their residents' retardation levels. As might be expected, th( reliability among their assessments. According to Wolfensb* first efforts were "to make the deviant undeviant" (1850-1! "sheltering the deviant from society" (1870-1890), and the society from the deviant" (1880-1900). The above circumstances led to Binet's work on a stanc of "inferior states of intelligence" for diagnostic purposes 1905). In 1904, the French Minister of Public Instruction cl sion to study the measures to be taken to ensure the "bene: to defective children." Binet wrote a scathing review of exis systems and then published his own test in 1906, to different ine meuicany onenieu institutions anu leu to a more cus approach, that is the self-contained colony or total insti attitudes toward people with ID soon began to reappear ar people with ID again emerged. IQ tests were given widely, not just in schools, but for a v< The Army General Classification Test was a group IQ test £ Stanford-Binet scales in 1917 when the United States entere the World War I, to classify army recruits for different job people who were unfit for military service. Inspired by nineteenth century hereditarians like Francis < the eugenics movement, several of its proponents like Te and Yerkes (who was then a colonel in the Army) proposed set immigration quotas for different races, as an argument and as justification for other discriminatory practices of tl order (Kamin, 1974). An example of their rhetoric follov (1916, 1917): "Children in this group should be segrej classes____They cannot master abstractions, but they car efficient workers____There is no possibility at present of cc that they should be allowed to reproduce... They constitute because of their unusually prolific breeding. If we won state for a class of people worthy to possess it, we must p possible, the propagation of mental degenerates... the inci degeneracy." Thus began the debate over heritability of intelligence, wl day (see Eysenck & Kamin, 1981 for an excellent summary o On one side were Terman, Eysenck, Jensen (Jensen, 19 who believed that 80% of intelligence was inherited; on Kamin and others who disputed the data, some of whicl (e.g., Cyril Burt's twin studies). Their view was that enviror pie caregiving environment, socioeconomic status, and oc parents also played a large role in determining IQ. This de the development of the culture-free test movement and to se concerning the use of IQ tests in school placement (Larry P /vka^-uo, n is ine major auvocacy organization lor pe the United States. Although there were early textbooks, for example Tredgol on the experimental psychology of "mental deficiency," as i began in earnest after the World War II in the 1940s (see Rc 2003 for a review). The American Journal on Mental Defici existence since 1895. Ellis published his Handbook of Mental 1 and Research in 1963 (Ellis, 1963). It was one of the first handbo* solely to reviews of research and theory, and it served as th< for many years. It is now in its third edition. Since then, many and annual series have been published on a wide variety of tof Research on educational assessment also began to app (PCMR, 1977). The federal funding for research in m( received a huge boost in the 1960s during John F. Kenn The National Institute for Child Health and Human Develo and the Bureau of Education for the Handicapped (BEH) 1963 and in 1968, respectively. Advocacy for special edu< great impetus from the Education of All Handicapped Act (since 1997 called the Individuals with Disabilities Educati< guarantees every school-aged child a free and appropri the least restrictive environment possible. For most chi] the public schools, which must be accessible and accomr disabilities. Thus their right to education is extended to tl Any school receiving Federal and State funds must compb or face losing its Federal and State funding. These and other federal agencies promoted basic and on the fundamental processes underlying assessments of Experimental scales and test batteries based solely on theo ability substructures, for example Clausen (1966), howe success. Psychometrically standardized tests based on " Stanford-Binet test, or on primary abilities, for example gence Scales (Wechsler, 1955), and behavioral assessmem example FA, have prevailed up to the present. JVS. zjgier {Lyoy) proposed inai ims uinerence was maim for higher functioning people and not a fundamental dif of motivation. Thus the developmental versus difference Zigler & Balla, 1982 for a summary) was born, and it preo the research of that period. It was also noticed that the variability of responsivenes people with ID than in typically developing people. Thii to "outer-directedness," "rigidity" (Zigler, 1966) and lac (Baumeister & Kellas, 1968). The interest in personality structure of people with ID Cc researchers at Yale University headed by Zigler and his col and Masland. Masland, Sarason, and Gladwin (1958) pub] early textbooks on "mental subnormality," which took an approach to biological, psychological, and cultural factors of research is still being carried on by their students. Pj approaches to psychopathology predominated in this scl (Sternlicht, 1966). Behavioral approaches to psychopathology began with p< and profound ID. Bijou (1966) and colleagues at the Universit Lovaas at UCLA and his students (Lovaas, Freitag, Gc 1965), Spradlin and colleagues at the University of Kans; Spradlin, 1964), and Sidman and colleagues at the Shriver ( (Sidman & Stoddard, 1966), as well as other behaviorists a States began dealing with basic skills such as daily living skills, and behavior problems like aggression and self-inj Two important societies were formed in the late 1960s: the Behavior Therapy (AABT) and the Association for Behavi former was broader and more eclectic, while the latter was analytic, focusing on single-subject assessment and interv< were behavioral and opposed to the psychodynamic zeitgeii Epidemiological research on populations related to ID als a boost. An early study by Heber (1961) put the preva retardation in the United States at 3%, a very significant meniai reiaruauon. ne cornea tne term auai diagnosis to who have both mental retardation and mental illness simult* number of pioneering child psychiatrists made people with population of professional interest. Many other handbooks followed in the next two dec devoted to all aspects of psychopathology in ID. At firs made to use instruments that had been validated on the typ population, for example the Conners Teachers Questioi 1969), but these often had limited validity for the more severely retarded population. In the 1980s, a second generation of new instrument assessing psychopathology in people with ID were develop' Screening instruments like the Reiss Screen (Reiss, 1988) an< the psychopathology instrument for mentally retarded aduli and the Diagnostic Assessment of the Severely Handk Gardner, Coe, & Sovner, 1991) were general multifactorial ment instruments that are still used widely for the diagnosis among people with ID. By 1990, Aman (1991) was able t instruments that had at least some validation research sup; They ranged from self-report scales to interviews, ra and behavior frequency measures. In the past 15 years m multifactorial assessment scales have developed which Chapters 5-9 of this volume. With the increased interest in genetics and in behavi (Dykens, 1995; Dykens, Hodapp, & Finacune, 2000), a n tion of assessment instruments has developed, in order to specific to the behavioral idiosyncrasies of different genetic independent scales have been developed, in order to assess n symptoms and their possible relationships to gene-brai: tionships. A good example is the battery of tests for rep< disorders, for example tics, dyskinesias, compulsions, stere injury developed by Bodfish and colleagues (Bodfish Lewis & Bodfish, 1998) or the Behavior Problem Inventc iv. moocooivicin i ur roTunurnMniviMUULUL In the 150-year history of research on the psychophar (see Schroeder et al., 1998 for a historical review), the < antipsychotic drugs in the 1950s caused a sea change in drugs, originally designed to treat schizophrenia and afl were used extensively on a trial-and-error basis with peoj had no formal diagnosis of mental illness. This practice led use and abuse, as pointed out in a critical review by Spr (1971). Their classic paper set the standards for acceptable psychopharmacology of ID: (1) double-blind, (2) placebo-ci pie standardized doses, (4) reliable evaluation of depe (5) random assignment of participants, (6) appropriate stc These standards, though rarely met due to limitations, the 1 consent and to their high-risk nature, are still the gold stam Since 1971, the use of psychotropic medications has decreas (Valdovinos, Schroeder, & Kim, 2003). Although they are still there are now state regulations governing their use, mon review, drug holidays, reporting of adverse drug reactions, < critical reforms all came about only with the developmen assessment instruments standardized on the ID population. W these trends briefly below. A fuller treatment is in Chapter 8. As in other domains, early research studies on psycho]: ID used psychiatric rating scales developed for the mentalh the Clinical Global Impressions Scale (Guy, 1976), and o questionable validity in the ID population. Some of them h at all or they were insensitive to drug effects (Schroeder, R 1997). The National Institute of Mental Health (NIMH) workshops in 1983-1985 with researchers who were using tl to discuss their use and to make recommendations. These published in two issues (Vol. 21, Nos. 2, 4) of the Psyc Bulletin in 1985. The results led to use of more standard procedures. The most powerful drug-sensitive and widely us correlated poony across uinerent scales, anu not at an behavioral observations (Schroeder et al., 1997); (3) the i side effects scales and measures of adverse drug effects wei the ID population, and new side effects scales, such as t MOSES, needed to be devised for this population (see Kalac excellent review); (4) it was rarely the case that a perse psychiatric diagnosis. Multiple diagnoses were the rule ra ception in this population (Valdovinos et al., 2003). Toge were the source of a great deal of variability in the data addressed in the future by a multimodal approach to appro observation sampling procedures (Thompson, Felce, & Syn specific and sensitive psychometric scales (Bodfish & Lewis, precise diagnoses to justify a more targeted neurobiologi using medication when it is necessary (Schroeder et al., 1% V. ASSESSMENT OF BEHAVIOR PROBLEMS SKILLS DEFICITS IN ID As Baumeister, Todd, and Sevin (1993), Aman, Sarph (1995), and Valdovinos et al. (2003) point out, the most psychotropic medications used for behavior problems am ID are the antipsychotics prescribed for behavior contr< self-injury, and property destruction. This has been th 1950s, even though these are not recognized psychiatric di IV (APA, 1994). The DSM has been slow to acknowledge ( prevalence and severity of some of the behavior problems t people with ID. Traditionally these problems have been ; behavioral research community. Matson (1986) called for a two systems of assessment, but it has not as yet happened. The vast majority of research on assessment and intervei ior problems in ID is published in behavioral journals lil Applied Behavior Analysis (JABA), Research in Developm more specialized scales, iiKe ine nenavior rrooiems invenioi 2001), are likely to continue as the prevailing instrument behavior problems in ID. Social skills assessments took on importance with the pi Vineland Scales of Social Maturity (Doll, 1965). Later the a scales (Nihira, Foster, Shellhaas, & Leland, 1975) became poj a formal part of the AAMR definition of mental retardatio revised definition (Luckasson et al., 1992, 2002). Concerns w tive behaviors were becoming of increasing interest as pec retardation were leaving institutions for community living, bu were not particularly helpful for prescriptive programmi: emphasized mostly negative behaviors and not their positive Since behaviorists were doing most of this type of sock they naturally turned to a task analysis, functional assess] teaching of the behaviors. One of the first examples of sucl the Mimosa Project at Parsons State Hospital and Training ( (Girardeau & Spradlin, 1964) where, using tokens as rewa severely retarded adolescent girls self-care skills, as well graces, for example sitting, eye contact, voice modulation, ft ing, ironing, shopping in the community, and other social s and Lawler (1964) reported on a similar program in an ed with severely and profoundly retarded children. Ayllon and Michael (1959) were among the first to propo application of behavioral principles toward management usi omy. Ayllon and Azrin (1968) published a comprehensiv( token economy system. This very heuristic book was an im and many replications occurred in institutions across thi Indeed we were working at an institution at the time in wl different token economies involving over 600 residents, « different levels of functioning. It had its own store, its ow: system, to adjust the value of the token, and so on. It beca that the state learned about it, felt it was a true economic s) and shut it down because they could not account for it in ine assessments were oenaviorai uemonsirauon 01 ine cc than a psychometric test. Since most of the programs i "treatment package," controversies developed over which j age were the essential ingredients. This was difficult resear it was labor-intensive and often it required a large number the ID population is very heterogeneous, this was often i: problems were lack of generalization and maintenance ac difficulty with people with more severe and profound ID developed booster retraining and training-the-trainer str these difficulties. VI. ASSESSMENT OF SPEECH, LANGUAGE, COMMUNICATION IN ID Language and communication are an integral part of ID, ai existence of language components on almost every IQ test. 1960s, the field of speech, language, and hearing, however, w; on speech articulation and speech impairments. Norm-referei Illinois Test of Psycholinguistic Abilities (Kirk & McCarthy, to prescribe rather nonspecific "psychoeducational" langu grams in the schools. Some textbooks essentially recommei language training among people with ID. The first systematic research program to study the cc people with mental retardation began at the University Bureau of Child Research and Parsons Research Center ir the direction of Richard Schiefelbusch and Joseph Spradlii Saunders, Spradlin, and Sherman (2006) give a concu Language and Communication Program at the University following section relies heavily on their historical account, ning, Kansas researchers participating in this effort ai speech and communication of children and adults with m could be improved by the systematic application of beha iney interacted, ine nrst language sampling assessment ins Parsons Language Sample (Spradlin, 1963). In the late 1950s and early 1960s, many prominent research States did not believe that the speech and language develop with mental retardation could be enhanced or modified in way via environmental means. Chomsky (1959), for examp] his criticisms of Skinner's book (Skinner, 1957) and had pre that generative grammar was innate. Statements by Cho psycholinguists about the innateness of language led Kansi initiate a series of studies which demonstrated that many < grammar, whether thought to be innate or not, could still bi the systematic application of sound behavior principles (Bae Guess, Sailor, Rutherford, & Baer, 1968; Schumaker & She: While these early studies were aimed at demonstrating aspects of spoken language could be taught, there was also the substantial importance of receptive language. Because he critical to such understanding and because there were nc evaluating the hearing of children with severe mental retc researchers at that time conducted a series of studies airr procedures for evaluating the hearing of such children. 1 to a set of procedures that could be used to evaluate su< audiometric procedures previously applicable only to pen stood and followed verbal directions (Fulton & Spradlin, 197 Lloyd, Spradlin, & Reid, 1968). Parsons researchers also atic study of the development of generative receptive langv they demonstrated that generative receptive language cou with many children, to at least a limited extent, by the sys tion of behavioral principles (Baer & Guess, 1971; Striefel & Striefel, Wetherby, & Karlan, 1976). These early successes i that some children with severe mental retardation could aspects of generative language led to subsequent attemp comprehensive program for language and communication dren with severe and profound mental retardation (Guess, 1978). rn^s system ^.Donuy ol rrosi, iyy^), are now usea witu communicators with ID. The failure of children who had been taught specific lang these skills in their daily environments also led Kansas resea look carefully at those environments. Observation of the chil environments (at that time these were typically institutional ( to the conclusion that they frequently did not have sufficien use their newly developed skills. These observations led to a opments. One development was that investigators began to the interaction of persons with mental retardation and their ( natural (i.e. noninstitutional) environments (Hart & Risley, of these efforts to observe children and their caregivers led a n another research program by Hart and Risley. In this researcl examined the communicative interactions of young childr environments who were just beginning to develop langua, resulted in the publication of a seminal monograph by (1995), that examines the development of language by chL syndrome in comparison to that of typically developing chik The observation that the systematic teaching of languag alize led Stokes and Baer (1977) to develop a model of the pi facilitate generalization. They proposed this in a classic served as a basis for both the experimental clinical analysis problems and tactics for nearly three decades. In the mid-1970s Kansas researchers began to develop intervention procedures to be used in the children's natu to aid them to acquire and use new skills (Hart & Risley, 19 Sherman, 1978). Hart and Risley (1975) developed an im technique that encouraged children to request objects in tli ments. Pla-Check assessment systems for sampling behavic settings were developed in this program. Halle and his c Baer, & Spradlin, 1981; Halle, Marshall, & Spradlin, 19; that if one introduced a delay between the time that a child n request and then prompted speaking by presenting a sp person would often begin requesting with speech after a fe\ umier, ei ai., zulo;. ao lerman s ^i^io; previously cneu gene no abstraction among people with ID were slightly inaccurat Research on speech, language, communication, and ] has exploded since the 1980s. Several large handbook seri The first was a 20-volume series published by Univer with Schiefelbusch and colleagues as editors. The second ^ series published by Paul Brookes Publishing Co. with Ste1 Reichle, and Marc Fey as series editors, which continues 1 above behavioral research has used primarily the master language abilities as their assessment measures (Sundberg has developed a wide array of valid and reliable measu development (Warren & Yoder, 1997). Standard compu for analysis of language samples are now available (Evan excellent book on the assessment of language relevant to IE and Thai (1996). VII. WORK-RELATED ASSESSMENT IN II With the deinstitutionalization and community integratk the 1970s came a renewed emphasis on assessing and d related behaviors in ID, in order to foster productivity an The federal Rehabilitation Services Administration (RSA) lished after the World War II, to help wounded veterans' n reentry into the nation's work force. This large federal age network of branches in every state, which determined eligib itation counseling, and monitored of clients' progress regu these services were extended to people with mental illness, as with ID, in the Rehabilitation Act of 1973. RSA was not set up well for people with ID, and initi great deal of resistance accommodating the new populati were again norm-referenced aptitude tests, like the Purdu uarj^a, wiin i^avia uray, a quauripiegic anu a strong atr director. The newly formed Rehabilitation Research and Tr NIDRR stressed consumer control, self-determination, ai which relied heavily on structured interviews of people assessment tools. Since that time a host of work-related programs for pe addition to other disabilities, have developed. A large attei move people with ID from sheltered employment into compel in the community. Out of this impetus grew the supported er ment (Rusch, 1990; Wehman, 1981; Wehman & Moon, 198 sample and vocational testing methods were largely discarde performance skills on the job became the main set of assessn Supported employment has been a successful progran totally replaced sheltered employment facilities. Only a sm people with ID in supported employment work full time or itive wage today. It was found that the main reason fo supported employment was not so much the quality of th< lack of social skills in the work place, lack of responsibility, such as their health, the economy, or intolerance of their fe managers (Lagomarcino, 1990). Recent programs have foe work-related social skills or self-employment (Chadsey-Ru & Hammis, 2003; Luecking, Fabian, & Tilson, 2004; ]\ Oliphant, Husch, & Frazier, 2002). The Americans with Disabilities Act (ADA) was passe G.H.W. Bush administration. It had many far-reaching p which was that it prohibited discrimination based on It required employers to make reasonable accommodatic person's disability, so that now even people with severe ID to work. A large body of case law governing the ADA has d< past 15 years, but much of it has been gutted during the pi Supreme Court during the G.W. Bush administration (Stc Sublet, 2006). Total US public spending for ID has deer (Braddock & Hemp, 2006). important, i ne nrst assessment scaie in lij witn empiric by Schalock and Keith (1993). It was similar to QOL scales health field and in the field of aging. It covered eight domains being, interpersonal relations, material well-being, person physical well-being, self-determination, social inclusion, and of these domains has become a subfield of extensive resea has spread to the international arena (Schalock et al., 200 Schalock et al. (2005), QOL has become a "sensitizing notion, and overarching theme for planning, delivering, and evali lized services and supports." Assessment research on QOL c rapidly, especially in the United States and Europe. Another research initiative that emerged with the comm in ID in the 1980s is adaptation to having a person with (see Stoneman, 1997 for an excellent overview). The areas of s stress models (McCubbin & Patterson, 1983), buffers and c (Turnbull et al., 1993), family systems theory, social roles (S Davis, & Crapps, 1989), and ethnographic approaches (Gal Kaufman, & Bernheimer, 1989), models of grief, resilience empowerment (Turnbull & Turnbull, 2001). Much of the as; areas is qualitative or ethnographic in nature; but there are a tative direct observational studies of social interactions, as \ questionnaires, ratings scales, and so on. Family studies in I] very large area of research in the last 20 years and they promise in the future, as people with ID increasingly come to live in tl IX. INTERDISCIPLINARY TEAM ASSESSMEN1 The assessments described above have become tools of teams. Interdisciplinary teams have a long history and he medicine, education, and rehabilitation since the 1920s ( Interdisciplinary teams did not start to gain momentum un centers were established during World War II. Professional: a number of specialities were needed to adequately assess a: neeueu to oe proviueu in an interdisciplinary lasmon. ine cc mended that centers be established for the interdisciplinary t sionals who would eventually work with people with me University Affiliated Facilities and Programs were develop States to meet the need of training professionals to work in co Mandates for collaborative interdisciplinary teams became tional law in 1975 with Public Law 94—142, Education of Act and subsequently the IDEA. Both University Affiliate< University Centers of Excellent in Developmental DisabL continue today with emphasis on interdisciplinary assessmen education and treatment (Garner, 2000; Rainforth, York, & I Thayer & Kropf, 1995). Presently, interdisciplinary teams who support individi retardation to function in their home community are made up range of participants than therapeutic professionals such < workers OTs, PTs, speech and language pathologists, ai Parents have always been important team members but mo: may represent a broad membership base and include clergy, portation specialists, and city planners. The goals of teams a only specific functional skills such as speech, social skills, and but also a person's QOL including relationships with noi and the ability to function as valued citizens in self-deterr employment settings. Many person-centered planning team neighbors, community members, and so on who meet on a move the person with mental retardation forward in improv lifestyle (Kincaid, 1996). X. SUMMARY AND FUTURE DIRECTION The above brief overview attests to the growth and de^ field of assessment in ID over the last century. The future pn prolific expansion of existing domains as well as developrr Some trends are as follows: great advantage in tne neiu 01 learning uisaDiimes ana snou in ID. Although used in some psychopathological and p logical research in ID, the multimodal approach has not ga popularity in the rest of the field. 3. Social validity assessments, although recommende 25 years (Kazdin & Matson, 1981), have also not been us( future, they are likely to be required more frequently, in oi access to research populations in ID. 4. Interdisciplinary assessment is increasingly becoming important part of assessing people with mental retardatioi expensive, its wise and efficient use may save money in the ] of its emphasis on prevention of disabling conditions. The importance of defining and characterizing populatioi ID cannot be overemphasized. Improving our assessments 1 delineate subgroups empirically and thereby to sharpen tl genetic syndromes and to relate them to brain function and day in the near future, there may be cures for some forms therapy and organ repair with stem cells. Behavioral ai assessments have an integral role to play in these hopes anc ACKNOWLEDGMENTS We wish to acknowledge MCH Project No. MCJ 944 and the Social Sec for partial support in preparation of this manuscript. We thank Michael Wi reading of the manuscript. REFERENCES Aman, M. G. (1991). Assessing psychopathology and behavior problems in retardation: A review of available instruments. Rockville, MD: US D and Human Services. tsaer, u. jvl., , a mean v jv score 01 ou.i, anu a mean r Mean index scores in this sample were as follows: VCI = 6 and PSI = 63.3. For individuals with moderate mental retar FSIQ score was 50.9, while the mean VIQ and PIQ scores we respectively. Mean index scores for individuals with moder; dation were as follows: VCI = 56.8; POI = 58.9; and PS scores were not obtained, as individuals were not given the Sequencing subtest, a necessary component of this index sc mean scores were found in Arithmetic in both populations, e tions scored relatively poorly on Symbol Search. However, been found in studies with children with mental retardation, sample provided did not receive a relatively higher PSI scoi IX. NONVERBAL INTELLIGENCE TESTS FREQUEN TO ASSESS FOR MENTAL RETARDATION A. Leiter International Performance Scale The Leiter International Performance Scale (Leiter, 1948 preeminent, individually administered, nonverbal, standarc test. Despite some test limitations reported by Sattler (1992 preferred nonverbal instrument used in the field until a revisioi Leiter International Performance Scale-Revised (Leiter-R) 1997) came to the market. However, this original instrum have merit (particularly in evaluating for mental retardation and adolescents) and be worthy of discussion despite the gen Ethical Standard 9.08 in the American Psychological Associat (American Psychological Association, 2002) regarding use of The original Leiter and the Leiter-R are quite different i regard to test materials and the mechanics by which the exa tasks. While the Leiter-R requires the examinee to engage learns wnat is expecteu in terms 01 periormance. in tms repeatedly experienced in our clinical practice that, for e: these, frustration with the Leiter-R can ensue because of th and that our examinees require repeated "learning" peric just give up. Yet, these same examinees persist in an uninten the original Leiter. Thus, we have retained the original Leit< ry of standardized IQ test materials, and encourage evalu this instrument if the Leiter-R proves less than successful. The original Leiter International Performance Scale (I nonverbal test of intelligence for individuals, 2-18 years oi most frequently used to evaluate the non-English speak disadvantaged, and those with hearing or speech deficit! language handicaps, motor deficits (including cerebral p problems. It also has proved quite useful in the evaluate with autism and/or mental retardation. A history of the instrument (including preparatory work, revisions, and ad; found in Gabel, Oster, and Butnik (1986) and Sattler (199^ The original Leiter requires an examinee to mat corresponding strips positioned on a slotted, wooden frai standardized subtests divided into three trays of blocks a: covers years 2 through 7, Tray 2 covers years 8 through 12, i years 13 through 17. This Binet-type years-scale has four year level from year 2 through year 16, and six tests at year 1 measured are: Concretistics (matching of specific relatior Transformations (judging relationships between two events), criminations, Spatial Imagery, Genus Matching, Progressive and Immediate Recall. Instructions to the examinee are given in pantomime by < the materials in a specific fashion or completing a portion demonstrate the problem-solving strategy. Examinees are considerably below their chronological age which allow; understand the general problem-solving expectation of this no time limits to this scale except on three separate subtest on ine eeiier is useu to ooiam an iv^; oy ine ratio meinou ^ 100) (mean =100, SD = 16). It was later recommended that points be added to this IQ equation because the original no underestimate children's intelligence (Leiter, 1959). A thoroi General Instructions for the Leiter International Performan 1969) is vital as there are some scoring peculiarities to it scoring adjustment is made to the examinee's mental age, additional scoring caveat once the examinee reaches chrono The format for reporting Leiter scores and qualitativ performance on this test is described in Exhibit 2.2. B. Leiter International Performance Scale-Revised The Leiter International Performance Scale-Revised (L( Miller, 1997) is the long-awaited update to the Leiter Intel mance Scale (Leiter, 1948). This individually administered, dardized intelligence test assesses the cognitive functionin] 2 years, 0 months to 20 years, 11 months. Like the original Le was developed to be used with individuals who could not validly assessed with traditional intelligence tests. Specifics duals include those with communication disorders, heari motor impairments, cognitive delay, traumatic brain injury, disorder, types of learning disabilities, and English as a seco The Leiter-R emphasizes fluid intelligence. Thus, the test that the derived IQ is not significantly influenced by the lev the individual's educational, social, and family experienc measures the IQ range of 30-170. Thus, it would be an app assessing those individuals falling in the mild to severe retardation. The Leiter-R consists of 20 subtests organized into Reasoning, Visualization, Memory, and Attention. The 1( Visualization subtests assess visualization, reasoning, anc Together, these subtests make up the Visualization and provide an estimate 01 giooai nonveroai intellectual level. 11 score that a cognitive deficit could be determined, and, in deficit scores in adaptive functioning, a diagnosis of mental be made. The examiner also has the option of administering Batteries together. This may provide information regarding i of cognitive-processing deficits in memory or attention on t\ ation of global intellectual ability. For example, if a child 1 dificit disorder is highly distractible or presents with severe se deficits, the AM Battery could provide evidence to "rule < diagnosis of borderline intelligence or deficit cognitive funct In addition to a traditional composite IQ (with a mean < 15), the Leiter-R provides subtest scale scores (with a mean o percentile scores, and age equivalence scores. The latter sec understood by parents and others with whom the test resull The Leiter-R also has four rating scales (Examiner, Parent, 5 which offers multidimensional behavioral observation infor individual. In addition, the Leiter-R provides Growth Sec assessment of individuals with severe handicaps. Specific; enable professionals who reevaluate the cognitive develop and adolescents with severe mental retardation to measu: important, improvement in their cognitive skills. Thus, tr improvement across time can be ascertained (regardless of i as well as ascertaining the likely efficacy of current educatioi programs and areas where modification(s) in programming n For the Leiter-R, the test developers reduced the ph the original Leiter kit and provided improved hygienic testi: original Leiter wooden blocks have been replaced by colorful cards, and foam rubber manipulatives. Test materials also i card stimulus easel books that include examiner directi materials. Neither the examiner nor examinee is required to spea does not need to read or write, either. The Leiter-R require place the cards and manipulatives into "slots" in the " suDgroups 01 atypical cnnaren ana aaoiescents imciuamg i nosed with mental retardation). The Leiter-R mean comp individuals in the cognitive delay (mental retardation) clinic 62.7 and 55.4 for the 2-5 age group and 6-20 age group, respec and validity are extensively described in the test manus correlates .85 with the WISC-IIIFSIQ and .85 with the origin* In addition to being a measure which can provide ability tive to small increments of improvement in cognitive ability, be a useful, nonverbal alternative for early identification of (2 years, 0 months up to 5 years). It also can be a useful, nc tive for the assessment of cognitive functioning in individ mental retardation when a professional team is charged w transitional services from school to postschool activities (t; when a child is between 14 and 16 years). X. SPECIAL CONSIDERATIONS IN TEST ADMINIS FOR CHILDREN WITH MENTAL RETARDATI' Cognitive testing is a skill that requires advanced trainin practice (Sattler, 2001). This is especially true with regard 1 dren. In order to obtain an optimal performance from a ch must possess flexibility, creativity, patience, attentiveness, tremendous affinity for children. Children with mental retar ent even greater challenges to the test administrator, presen deficits that may reduce the likelihood of obtaining an indivi performance level. In order to obtain the most accurate assesi functioning level, the examiner must be extremely vigilant ar factors. This generally requires a great deal of skill and pr< part of the examiner. In particular, it is helpful to become fa common problems and solutions associated with assessing These difficulties include problems with attention and foci mood, fatigue, motivation, anxiety, rapport, and communic to tneir state, requiring tne examiner to oe vigilant to & changes. In attempting to obtain the maximum performan a child's attention, it is important to provide multiple breal cues for attention and focus, and provide frequent feedbac the form of "I like how hard you're trying."). Finally, if takes a prescription medicine to assist with attention, this m used during an assessment of cognitive ability. Signs of fatigue may manifest in a number of different \ signs of fatigue in children with mental retardation may inc such as yawning, slurring of speech, drooping of eyelids, slo1 ments, resting of the head in the hands, putting the head dc irritable. However, children with mental retardation also i fatigue by becoming suddenly oppositional, requesting to lei bathroom, starting to cry, becoming restless, or resorting to 5 "I don't know" answers or nonresponses. At times, cognitiv related to the specific cognitive demands of a subtest. For with language difficulties may appear exhausted when respoi ended verbal query, but may "perk up" after moving on to visual, such as a matrix-reasoning test. In this case, simp different test modality can help to ameliorate fatiguing. Hov with slow processing speed or limited working memory caj sistently demonstrate fatigue as the cognitive load of th regardless of the ability being taxed. A child's cognitive anc limitations will require the examiner to be much more vigil level of fatigue. Rarely will a child with cognitive limitationj for a break, yet a lack of appropriate accommodation coulc down," in which the child no longer is able to function : capacity. For this reason, the examiner should maintain an child's cues that he or she is having difficulty, providing br activities when possible. Often, it may be helpful to allow tl small amount of a drink, a snack, or a walk down the hal] particularly intractable, it may be necessary to administer tl sessions. It also is important to remember that, for some aumimsiraiion (jonnson, crauiey-jonnson, ivic^ariny, ol jan stickers, pencils, or small pieces of cookies or crackers as a n on task and working hard is an effective practice. However, it reinforcement is provided in a manner that does not break protocol of the test being administered. Obviously, reinfi be given for effort, not correctness. Furthermore, it is critii approval of the child's parents or caregiver when providing This is particularly true with food, as children with mental have food restrictions due to allergies, metabolic issues, chewing and swallowing, and/or cultural/religious beliefs. Communication problems and anxiety may negatively a mance in cognitive assessments (Lezak et al., 2004). In mental retardation, it may be particularly challenging to e and decrease anxiety. Many children with mental retardat speech and language delays, and may not always find con words (Spruill, Oakland, & Harrison, 2005). They also may 1 and frustrated by the verbal messages presented to them. Su use alternative means of negotiating and understanding th For example, they may read a person's face and tone before words spoken. For this reason, children with mental retardai particularly anxious when working with an examiner who vacant and expressionless during test administration. Indivi< tive deficits may tend to interpret this behavior as an indi have done something wrong (Lezak et al., 2004). Therefo must endeavor to communicate messages of warmth, posil forcement, comfort, patience, and a sense of fun through the and affect. In addition, young children, who may be wary c need a transition object available to help them adjust to the young children or children who are particularly anxious, ha\ the testing room may be the only means of ensuring an optin In this case, the parent always should be behind the child sc not distracted and does not look to the parent for testing < also should be instructed not to help or encourage the child A. Test-Specific Considerations Specific tests of intellectual functioning also may present i in test interpretation when assessing individuals with me A few of these challenges are reviewed below. 1. THE WECHSLER SCALES Overall, the Wechsler scales provide rigorously researcl valid measures of an individual's intellectual functioning Wechsler tests have been the preferred tests of intellectu children since the 1960's, and there are no tests that are accepted and approved for the purpose of establishing men children (Prifitera Saklofska, Weiss, & Rolfhus, 2005). 1 improvements from previous versions, the instructions on tfi still appear to rely heavily on language. This may be a partic young children with cognitive impairments, who often shovi and language. In addition, the paucity of manipulatives on tb make it a bit less appealing to young children than some c current use. Finally, it is important to remember that the We not designed to test children functioning below the moderat retardation (Psychological Corporation, 2002a,b, 2003). In Cc lower ability level is suspected, alternate measures should be When using a Wechsler test, one practice that should be tc is that of using alternate starting points. When testing indr of having significantly subaverage ability, it may be advi: start points that are more reflective of the individual's su mental age. Thus, the examinee will be more likely to feel first item presented. Doing so may help to improve rapport and decrease anxiety and fatigue. On the WAIS-III, age-re are not given; rather, all individuals begin at the same point if they do not obtain the requisite number of basal items cor /\ concern inai arises wnn ine newer wecnsier scales is processing speed measures in the calculation of the FSIC While the processing speed factor may indeed provide cli inclusion of this time-dependent measure may lead to attei in children with fine motor difficulties, attention deficits, s anxiety, depression, and/or those taking certain medication! important, as always, to carefully scrutinize the child's sec all other data presented (Sattler, 2001). It should be not common for a typical child with mental retardation to pn that is significantly lower than other index scores. The c generally the case, wherein the PSI tends to be slightly high VCI and PRI in children (but not adults) with mei (Psychological Corporation, 2002a; Spruill et al., 2005; \ Zhu et al., 2004). In the event that an attenuated score i Wechsler scales provide alternative means of obtaining a score, such as through a General Abilities Index (GAI), or tl of scores (Prifitera, Saklofske, & Weiss, 2005; Psychologic 2002a,b, 2003). 2. THE DAS The DAS is a well-standardized measure of cognitive al and adolescents. However, one drawback of the DAS relate mental model employed in test creation. While this model useful information in treatment planning and diagnostic ( and may be argued to be a more appropriate way to measi cause problems for longitudinal comparison. The probler child reaches a certain age, constructs such as verbal ability < using the same tasks on the DAS. Consequently, it may be di child's growth in a specific area of development. Although opers contend that the different subtests used at different c similar constructs, there are subtle differences that may be vant in different children. For example, at different age unrelated to the construct being tested are taxed unequall) Ai. i nt rlt i\in trrcu i: iu o^unw minu ivit RETARDATION DIAGNOSES Given the content of this chapter, these authors would reporting on the Flynn effect. The Flynn effect is a phenon via massive data analyses, by James R. Flynn, a politics University of Otago in New Zealand, and reported on in « (Flynn, 1984, 1987, 1998, 2005, 2006). Using IQ test data fi the developed world, Flynn discovered there have been ] from 5 to 25 points in a single generation (Flynn, 1984, effect is stronger on tests which measure fluid intelligence (in for on-the-spot reasoning, abstraction, and problem solving crystallized intelligence (intelligence centered on accumu such as vocabulary, arithmetic, and general information), effect has been most dramatic on data analyses using the Rc Matrices, a test of fluid intelligence. On the Ravens, the Flyi a gain of 21 points in 30 years (around .7 point gain per yea been less dramatic but still impressive on data analyses us scales and the Stanford-Binet series, IQ tests which measur fluid intelligence. On these tests, the Flynn effect has beei points within 45 years (around .3 point gain per year). Further, when reviewing Wechsler VIQs and Wechsler covered a 10- to 20-point increase in the Wechsler PIQs heavily loaded on fluid abilities) and a 9-point increase in tf (which are more heavily loaded on crystallized abilities) (Fl In these same studies, when comparing the WISC with found that individuals tested on the WISC-R had to answe correctly, or had to answer harder questions, to obtain the the WISC. At a later point, Flynn (1998) estimated the m FSIQ scores between the WISC-R and the WISC-III to be i 1998). From a practical perspective, this means that someoi score of 105 on the WISC-R would, on the average, receive the WISC-III. lyyj; aiaie ^aarmo, iyyj; vance, iviauuux, runer, points in the mild mentally retarded and borderline range; the same magnitude that Flynn found in the middle of the Flynn (2005) has stated that there is overwhelming evidence are at least as great for individuals' test scores in the low leve as they are with individuals' test scores in the average range Overall, the findings indicate that as time passes and I( people perform increasingly better on an IQ test, raising several points within a matter of years. Once a test is r typically happens every 15-20 years, the mean is reset to test harder and "hiding" the previous gains in IQ scores. B< effect takes effect immediately on the introduction of a new I1 are most valid at the times the norms are released. Although there is no consensus among professionals as tc are occurring or what the gains actually mean (with possi including genetics, SES, higher education levels, increased ability, and increased test sophistication), all are in agreeme occur and that they hold significant theoretical and pract In this regard, Neisser (1998) has provided a review o] importance. Specifically, with regard to the mentally retarded popul effect raises particular concerns in a number of areas. Fin (2003) point out that because of the systematic increase in past 80 years (the Flynn effect), there is reason to believe th; are diagnosed as mentally retarded based on the year in whic and test norms used rather than on their cognitive abilit; age on various IQ tests, fewer children are diagnosed as n (in the mild range) as more children's IQs rise above the man replacing inem lmmeuiaieiy wnn newiy normeu tes within the same school district, multiple psychologists ma] tion services to a district. As a result, different children r different versions (norms) of the same test in the same scho nately, in this latter case, these IQ test scores are still co] another, regardless of the fact that different norms were use are assigned accordingly. Consequently, two children in th( with the same cognitive ability could be diagnosed different different test norms were used for each child. Overall, Kanaya et al. (2003) indicate that the times t cautious are when a test is either at the beginning or at the e cycle, with a test being least valid when administered at thi Needless to say, evaluators always have needed to exercise < on an IQ to diagnose mental retardation. Knowledge of the awareness that the effect impacts the lower end of the IQ di as the average range of the IQ distribution dictates that evali for presence of mental retardation seriously consider the F diagnostic process. Currently, methods to control for the ] yet to be formally considered and debated in the lite: Greenspan (2006) has advocated the necessity for evaluati down with each subsequent year in the norming cycle of a to control for the Flynn effect. Flynn (2005) and Greens offered possible formulae to do so. In addition, some consideration might be given to h formal time limits by which evaluators must begin using tl of a test once the new version has been formally introduce place. However, adherence to such regulations likely wou enforce given the reported budgetary constraints of many sc mental health agencies. Further, this could provide test putt encourage premature and unnecessary test revisions. Fin; stance in this matter could prohibit the sometimes necessa: of older editions of some instruments in particular clinic* (e.g., use of the original Leiter as described earlier in this d some comments can oe maue nere. First, because the diagnosis of mental retardation has s on the child or adolescent's life, the psychologist must be c rate in reporting test findings. Further, the psychologist mui presenting all required data consistent with the definiti< making a diagnosis of mental retardation. As described at this chapter, the diagnosis of mental retardation should nev< on the standardized intelligence test score alone. At minii should include the documentation of significantly low pe nationally standardized measure of intelligence and below-adaptive behavior in a variety of settings. A thorough, pre ment also should include multiple sources of test informatior behavioral observations in school, home, and/or other sett caregivers, developmental, medical, and social histories, ai sources of evidence. With regard to the standardized IQ, itself, psychologist! tious when interpreting a low IQ that may reflect condition intellectual ability. Low scores can be attributed to a variety alone or in combination. This issue was extensively reviewed this chapter. Psychologists also must rule out potential coi eses concerning the child or adolescent's test performan their concerns in the report, before concluding the child manifesting mental retardation. However, even if the psychologist provides all this infom less than adequate report can still result. Indeed, we hav( of poor report writing. While the majority of psycholog "required" information, many psychologists report each 1 scores and data as separate and disparate entities, without the information into a cohesive, meaningful whole. This lea1' gist at risk for not addressing sometimes contradictory in evaluation (e.g., poor visual-motor integration skill on one t visual-motor integration performance on another instrumei positive progression ana development, uoou report writing as it is a science. In addition, if the psychologist is clear that the diagnosi dation, they should not be fearful to use the term "mental re written document or during the face-to-face feedback with takers, and/or school system. In the long run, it does not sei to skirt the issue. However, it is the responsibility of th( clearly define what mental retardation is and what it is noi other diagnosis being reported) as the parents, caretakers,< have an incorrect understanding of the diagnostic term(s). Recommendations contained in the report should be cle They should be driven by what the child or adolescent need institution's budgetary restrictions. The report should be co a fashion so it is readable by parties with varied levels ( familiarity with the tests administered. Finally, the report s respectfully in all aspects as this document will become pa adolescent's formal record, will follow the child or adolesce] to come, and may be the foundation for subsequent evalual dations, and treatment services with this individual. If infor child or adolescent's family situation is included in the f( psychologist always should be truthful but simultaneousl; strate respect for the family and exercise discretion in how ft stated. The parameters of confidentiality must be follow respect for the family must be maintained. XIII. SUMMARY Mental retardation is a categorization for a heterogeneo viduals with concurrent deficits in intellectual and adaj manifest prior to their 18th birthday. The diagnosis is m; etiology. Mental retardation is neither a mental disorde 01 imam i^eveiopmeni, aeconu cuiuon, ine nayiey acait Toddler Development, Third Edition, the DAS, the Mc( Children's Abilities, the WPPSI-III, the WISC-IV, and tl well as, the Stanford-Binet Intelligence Scales, Fifth Ed original Leiter International Performance Scale, and the Lei Performance Scale-Revised. The history, conceptual bases construction, psychometric properties, testing procedures, s< and examiner qualifications, as well as, indications and cont the use of each test is reviewed in detail. Measures of intelligence play a crucial role in the assess and treatment of children and adolescents with mental ret gence tests may be administered for a variety of reason identification of an individual's relative cognitive strengths are among the most pertinent with respect to customizing occupational programming. Therefore, it is not good cli] become familiar only with a single standardized test of make determinations based solely on its findings. Differenl various elements of the construct of intelligence. Best pr require psychologists to become thoroughly familiar with i intelligence tests in order to ensure that the proper test is sele findings will be valid and applicable to the individual being ness of the range of available tests also allows for the option assessment tools to derive the most accurate information n vidual's cognitive and adaptive ability. This approach furt probability that test results will be accurate and contribute ment of a successful educational program, occupational trail treatment protocol. There are no shortcuts to competency in terms of test se tration, scoring, interpretation, and report writing. Adequa tice, and clinical supervision are the mainstays of competerj intelligence testing when confronted with the complex task diagnosing mental retardation from a host of similarly ap] mental disorders and learning disabilities. Psychologists mus reiaruauon;. As a final note, it is important for psychologists to be av effect and its relevance to the diagnosis of mental retardatioi of the Flynn effect is particularly relevant when a psychologi to testify as an expert witness for the Court and make a diff< of mental retardation as opposed to a learning disabilii disorder. Nowhere will a psychologist's competency invo testing be more transparent than when it involves educating fellow professionals (e.g., judges, lawyers, psychiatrists, an as to the many facts involved in the determination of intell REFERENCES American Association on Mental Retardation (AAMR) (2002). Mental n classification, and systems of support (10th ed.). Washington, DC: Ai American Psychiatric Association (1952). 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Manual for the Wechsler Preschool and Primary Seal Antonio, TX: The Psychological Corporation. .Fsycnoiogicai corporation. Werner, E. E., Honzik, M. P., & Smith, R. S. (1968). Prediction of intelligi at ten years from twenty months pediatric and psychological examin« ment, 39, 1063-1075. Zhu, Z., Weiss, L. G., Prifitera, A., & Coalson, D. (2004). The Wechsler ] Children and Adults. In M. Hersen (Chief Ed.), G. Goldstein, & S. Comprehensive handbook of psychological assessment: Vol. 1. Intellec logical assessment (pp. 51-75). Hoboken, NJ: John Wiley & Sons. This page intentionally left institute, johns hopkins university school of m baltimore, maryland 21205 I. HISTORY AND DEFINITION Helping persons with intellectual disability (ID) reach the of independence is one of the most important endeavors who serve these persons. Adaptive skills are key to a independence. Indeed, training adaptive skills is among th( goals for increasing the independence of persons with ID (. & Bamburg, 1998). However, developing adaptive suppc should not be done blindly, but should be based on carei an individual's profile of adaptive strengths and weaknesse Adaptive behavior assessment serves three broad goals ( 2002). These include diagnosis, classification, and planning professionals are increasingly turning their efforts to pi; historically the primary reason for conducting adaptive behj remains that of diagnosis or classification. Nonetheless, tl adaptive behavior in regards to planning supports should n< The degree to which an individual can successfully per activities encompassed by the construct of adaptive behavic consistent basis, will have a large impact on decisions co the least restrictive environment (Pollingue, 1987). Furthe development is often the primary factor determining the le^ needed (Liss et al., 2001). Heller, Miller, and Hsieh (2002) tive behavior skills were higher in those residents who mov settings than those who stayed in nursing homes. These higher adaptive skills both before and after community plac that not only were adaptive skills improved by communit they were also indicative of which individuals would move i INTERNATIONAL REVIEW OF RESEARCH IN MENTAL RETARDATION, Vol. 34 0074-7750/07 $35.00 99 ( DOI: 10. muiviuuais oenave in everyuay me ana lor ine diagnosis to i weighted by how they perform on measures of academic inte ID is a classification that is used to determine eligibi Throughout the past 100 years, researchers and policy make with the basic problem that is common to all decisions reg for services; that is, to include those in need of assistance a who are not. On one hand, the definition of ID must be bro< exclude any individuals who should be included (type 2 err< definition should not be so broad as to include individuals 1 additional support (type 1 error). The construct of adapt] emerged as a result of these efforts to balance these two (Greenspan et al., 1996). According to the Diagnostic and Statistical Manual of A Fourth Edition Text Revision (DSM-IV-TR) published t Psychiatric Association (2000), adaptive functioning refer tively individuals cope with common life demands and ho) the standards of personal independence expected of someo cular age group, sociocultural background, and communi DSMTV lists four levels of ID: mild, moderate, severe. While significant limitations in adaptive functioning are a di ment, the actual measurement of adaptive functioning ii briefly. Further, the DSMTV's levels of ID are based solely c intellectual functioning. This method is particularly strikir DSMTV's own statement that "impairments in adaptive fu than low IQ, are usually the presenting symptoms in individ Retardation" (p 42). In response to this inconsistency, some that even though the DSMTV indicates the use of well-standai scales to assess adaptive functioning, than having no stand cutoff points that establish what "significant limitation in ad are, implies a general mistrust of the comprehensiveness <. adaptive assessment measures (Reschly, Myers, & Hartel, these same limitations apply to measures of intelligence as are akin to all norm-referenced assessment tools. component, ine most wiueiy citeu uenmtion 01 adaptive oe forth by the American Association on Mental Retardation recently, the AAMR has stated "adaptive behavior is conceptual, social, and practical skills that have been lear order to function in their everyday lives" (Luckasson et al adaptive behavior is not merely one's ability to perform ac It is a much broader concept that includes ones ability to < to everyday settings and situations (Greenspan et al., 1996^ The American Association on Mental Deficiency (since AAMR) formally added adaptive behavior to the definitk (Heber, 1959). By adding adaptive limitations to the defi] AAMD attempted to correct the over reliance on IQ scores tl as well as to reduce the number of individuals without signific; everyday tasks who were being classified as evincing ID base standardized IQ test score (Luckasson et al., 2002). Nonet standardized assessment measures of adaptive behavior were 1973, as social and legal pressures increased to require va measurements to be used when determining a diagnosis of II The 1992 definition of ID by the AAMR made significa overall diagnosis and classification of ID. One of the most that came with the 1992 definition of ID was in regards t of adaptive behavior. A shift was made from assessing a in general to assessing adaptive skills across 10 categories, time of the publication of the 1992 definition, there were no s to assess all of these 10 areas, and there was little agreem< necessity or adequacy of these 10 skill areas. Indeed, Lucka list the changes regarding adaptive skills assessment as on reasons for a general lack of adoption of the 1992 definition empirical support for the 10 skill areas, the 2002 definition al three broad areas of adaptive behavior composed of the 10 The current AAMR definition puts equal importance on and adaptive skills. Further, with the 1992 definition, a pa made in that persons are no longer classified according to the overall structure of adaptive behavior. An understandhij of adaptive behavior will change the way in which it is measi by practitioners. Much debate has been over the issue of whether or not an a is a unified or multivariate construct. To explore this questi» have been conducted examining the factor structure of adapti most comprehensive review is provided by Thompson, Bruininks (1999) who concluded that adaptive behavior i measured is a multidimensional construct consisting o Thompson et al. (1999) further noted that the number of f< related to the level at which the data were analyzed, with anal; the item level finding more factors than analyses conducted at 1 The five domains found by Thompson et al. (1999) w< independence, (2) responsibility, (3) cognitive/academic, (4) munity, and (5) physical/development. The first three facto commonly found in their review of factor studies. Regarding found in their review, Thompson et al. note, "no single adap behavior assessment instrument completely measures the adaptive and maladaptive behavior dimensions." In spite of these findings that support a multivariate m behavior, researchers and clinicians persist in using a unified a score for decision making (Lerman, Apgar, & Jordan, 2005). to practical concerns of meeting institutional standards or research design rather than a belief that adaptive behavior is b unified construct. Further, this tendency may simply be the r popular assessment scales providing a comprehensive score tt assume is the best representation of the adaptive behavior co III. REVIEW OF SCALES A multitude of assessment scales have been constructed, scales abound, research using adaptive assessment scales ha limited to three: the Vineland Adaptive Behavior Seal national service centers, i^uisem et ai. izuui; lounu tnat tr most widely used assessment scale in persons with autism three versions: a survey form, expanded form, and a c (Sparrow, Balla, & Cicchetti, 1984). The survey form anc are both versions of the interview edition. Sparrow et al. (1984) note that the VABS may be us assessment of a person's daily functioning is required. Tl are given in which the VABS may be used: diagnostic evali planning, and research. Diagnostic evaluations are listed s use of the VABS. In regards to program planning, M and Laud (2003) note that the VABS is useful for determir training; however, they recommend using more narrow-bai as the SPSS or MESSIER to provide more detailed infon social functioning or other particular domains of adaptive In a recent discussion of the VABS, Beail (2003) not advantages and disadvantages. The advantages listed inc the major domains of adaptive behavior, standardization, in metrics, and brevity (Beail, 2003). The majority of the disad\ to the "age" of the scale, resulting in outdated norms or n longer reflective of the target population. Beail noted that tl of the VABS had the potential to address many of these she The Vineland Adaptive Behavior Scales, Second Ec Sparrow, Cicchetti, & Balla, 2005) builds off of the foundatk Vineland scales. Due to its recent publication, the scale has r for researchers to evaluate. However, Sparrow et al. (20C of changes in the second edition that were made as an e measurement in very young children and adults. Many of the changes listed by Sparrow et al. (2005) at the utility of the VABS to measure adaptive behavior in pers mental disabilities, particularly for individuals with autis changes are the addition of items to measure the develo] language, the ability to maintain or initiate conversation, t< use nonverbal communication, and the ability to maintain so Further, items were added that address social naivete, gullibili B. AAMR Adaptive Behavior Scales The AAMR Adaptive Behavior Scales (ABS) is the secoi AAMD Adaptive Behavior Scale and consists of two versi Community (ABS-S:2; Lambert, Nihira, & Leland, 1993) an and Community version (ABS-R:2; Nihira, Leland, & Lamfc are two parts to the ABS. Part one addresses adaptive sk: independence. Part two addresses maladaptive behavior. It< to measure an individual's typical performance of adaptive The ABS-S:2 was standardized on both children with de abilities and those with typical development. Norms are pre duals aged 3-21 years. The ABS-S:2 is designed for identify are significantly impaired in adaptive behavior relative to theii ing an individual's strengths and weaknesses, measuring tr; and research. The primary use of the ABS-R:2 is for determining an in of adaptive strengths and weaknesses. The ABS-R:2 pro individuals with ID and is intended to be used with indi 79 years of age. However, norms are not available for typi adults. Thus, while the ABS-R:2 is reported useful for planni version should not be used to determine if an individual war of ID (Luckasson et al., 2002). C. Scales of Independent Behavior—Revised The Scales of Independent Behavior—Revised (SIB-R) interview that measures both adaptive and problem beha1 Woodcock, Weatherman, & Hill, 1996). The test is designed 1 tive functioning across a variety of domains. A number of i noted in the manual including identifying areas for train eligibility for services, planning programs and services, moni lized training programs, program evaluation, clinical asses and classification for research (Bruininks et al., 1996). The SI miernanzeu, exiernanzeu, ana asocial. The SIB-R varies from other assessment scales of this nat ity that it allows in its administration. While the standa: SIB-R is as a structured interview, a checklist-administrai available. As a checklist, a knowledgeable informant may co independently or a single respondent may complete check individuals at the same time during the course of a single in The Inventory for Client and Agency Planning (ICAP; Weatherman, & Woodcock, 1986) is a 16-page booklet that teacher or care person who is familiar with the individual be adaptive behavior subscale of the ICAP was constructed frc from the original SIB. The ICAP is designed to be complel short amount of time (15 min). The ICAP provides a wide i tion about the individual and it is not limited solely to me behavior. The majority of studies using the ICAP have focu of community integration. A number of well-developed adaptive assessment scales i choice of which adaptive scale to use should be determinec purpose of the assessment. Frequency of use of a scale does is the most appropriate for all occasions. While this review most commonly used scales (VABS, ABS, and SIB/ICAP), z assessment scales have been developed, such as the Battell Inventory, that also meet good psychometric standards (Res Not every scale possesses the same attributes such as admir age appropriateness of item content, or cultural relevance sionals must carefully consider their selection to ensure tha serves the intended purpose well. IV. PSYCHOMETRIC CONCERNS Issues of reliability and validity are common concerns f scales and are requisites for acceptance and utility (Amer Research Association, 1999). Researchers and clinicians st Basal and ceiling rules are used as a means to shorten the administer a scale. These rules are typically used by scales ac interview format that present items in an assumed devel By establishing a basal, it is assumed that the individual usu of the previous items that precede this basal level. Likewise, t that the individual does not or cannot perform the items folk Basals and ceilings are set once the interviewer obtains a ce items endorsed as present (basal) or endorsed as not present When determining the ceiling, scales in which ceiling score rapidly may underestimate an individual's adaptive behav skills have developed atypically. For example, persons with ments may show limitations on tasks requiring fine motor < score poorly on items concerning closing fasteners on clothi replaced buttons, dressing independently is no longer a te assistance but one that can be done independently (Pollii such an individual, an early ceiling would have indicated overall dependence than is necessary. Flexibility in establish is needed. One change made in the administration of the VABSTI fro a change in the basal and ceiling rules (Sparrow et al., 2( required full endorsement on seven consecutive items to < and scores of zero on seven consecutive items to establish a c and ceiling rules were relaxed for the VABSTI, requiring items to establish a basal or a ceiling. While this shortens tt time, it may negatively impact those individuals who dem development within the same domain. B. Item Sampling and Age Appropriateness Adaptive scales are often used to evaluate children fo delay. As a result many scales have the highest item de early development. This allows for a good degree of sensi may nave auapuve skiiis equivalent to iz montns 01 age, tn (e.g., items) should not be used to establish the adaptive 12-month old level as would be used for a typically d< For example, reaching for a caregiver may be an expec a 12-month old typically developing infant but would not I expect from an adult who is functioning at the same de^ nor would it be a behavior warranting training. C. Indirect Assessments and Informant Validity/Reliabi Due to limitations with communication skills or the direct observations, the majority of scales designed for i with ID rely on informant report. As a result, the utility of tools are dependent on the degree to which informants an reliably and validly concerning adaptive behavior. Most < have addressed this concern by reporting the reliability of different informants. While indirect assessment does have i tions, it allows for examination across multiple settings and r allows for the assessment of typical performance rather tha mance as would be seen if the individual were asked to perfc sake of assessment (Dykens, 1995). Adaptive behavior is relative and dynamic, not absolute ai Fuchs, 1987). For this reason, consideration of place and ti: when assessing adaptive behavior. Different skills are nee situations. Adaptive assessment needs to be broad and as multiple settings (Dykens, 1995). However, the same informal know or be able to report well on the adaptive behavior of the function outside of the context in which they know them (J Fisman, & Streiner, 1994; Voelker, Shore, Hakim-Larson, Discrepancies among informants, while a concern for reliat simply reflect the way in which the individual varies in adapth multiple contexts. Practitioners must use careful clinical juc investigation skills when dealing with such findings. et al. (2003) found that those children without autistic beh better across all domains of adaptive behavior but particula ization skills when compared to individuals with fragile X. I adaptive profile observed in autism, children with Wil showed relatively high social skills but lower daily living : skills (Mervis, Klein-Tasman, & Mastin, 2001). Carter et al. (1998) offer supplementary norms on the VAB with autism. These norms are helpful in that they provide description of the particular strengths and weaknesses for autism. However, it should be noted that when adaptive ments are used to determine diagnosis, the question is he performs relative to the general population, not simply to ot a similar diagnosis. E. Cultural Considerations Cultural considerations when assessing adaptive behavioi that adaptive behavior is defined in relation to social norms (Horn & Fuchs, 1987). For a scale to be useful it must a sensitive (Dykens, 1995). While most comprehensive scales assess adaptive behaviors that are culturally universal, this : that has been rarely tested. Craig and Tasse (1999) disci factors related to adaptive behavior expectations that ma} to an individual's culture. Among these factors are age structure, and attitudes toward disabilities. The age at which children are expected to perform specifi based on the culture in which the child lives. Further, the ta: child may also vary. Learning to read may be an importan developing within western culture. However, this skill may r ble within other cultures and thus not fit the definition of a< when measured outside of the usual context. Likewise, diffe expectations are common. Skills in one domain may be rec yiyyz.) nave ueveiopeu a translation 01 tne v/voa ana prese evaluations of the psychometric properties. Further res cross-cultural differences is needed. Not only are accurate lations necessary but also accurate cultural translations Research addressing these differences should lead to a bett regarding which skills are truly universal and which are c (Craig & Tasse, 1999). V. REVIEW OF PUBLISHED STUDIES The past 30 years have seen a tremendous increase in tl adaptive behavior as a consideration in the diagnosis of ID. researchers developed assessment scales to measure this c 1999). However, little is known concerning which adaptiv are used by researchers and practitioners. In a survey of Centers, Luiselli et al. (2001) found that the VABS was the used assessment measure. However, the study was limited t used in the education and treatment of individuals with au review is intended to provide information concerning whic have been reported in studies on persons with ID over the A. Literature Search A search was made for all studies, which reported the u behavior scale, that were published in four journals specializ persons with ID. The journals included in this search w< Journal on Mental Retardation, Journal of Autism and Develop Journal of Intellectual Disability Research, and Research Disabilities. All studies published in the selected journals fr 2005 were reviewed for the inclusion of an adaptive scale. A was defined according to the AAMR definition (Luckasso "the collection of conceptual, social, and practical skills learned by people in order to function in their everye B. Results The review identified 271 studies that included the use behavior scale. From the 271 studies, it is clear that nume scales have been used. However, the identified studies prims use of three scales: VABS (n = 111), ABS (n = 61), and SII Table I displays a breakdown of the identified studies ir assessment used and the population studied. The VABS was reported in 177 studies and was the included adaptive behavior scale. Of particular note is that ing on autism, the VABS was used almost exclusively. Tl commensurate with those by Luiselli et al. (2001) who founc the most widely used measure by practitioners for persons ^ current results indicate that researchers on autism, in ad tioners, also employ the VABS as the primary means to behavior. The VABS was used for a number of purposes in the ident most frequently reported use was as a general measure of ac In these studies, VABS scores were often contrasted to ot participant factors such as residential placement, autism dia tive abilities. The second most common use of the VABS wai individual's level of ID for purposes of group classificati describe the characteristics of the study participants. How reported using the VABS as a measure of maladaptive behs Sixty-one of the identified studies reported use of the AB regarding the VABS, the primary purpose cited for includi for a general measure of adaptive behavior. In contrast to tli a much larger portion of the studies including the ABS maladaptive or challenging behavior as a primary reason fc As noted previously, the residential and community versior not contain norms that represent both persons with and with this version is not appropriate for diagnosing ID (Luckase de Bildt et al. (2005) de Bildt, Kraijer, Sytema, & Minderaa (2005) de Bildt, Sytema, Kraijer, Sparrow, & Minderaa (2005) Billstedt, Gillbert, & Gillberg (2005) Burt et al. (2005) Chadwick, Cuddy, Kusel, & Taylor (2005) Dunn & Bates (2005) Edgin & Pennington (2005) Emerson, Robertson, & Wood (2005) Emerson (2005) Fine et al. (2005) Gena, Couloura, & Kymissis (2005) Gross (2005) Harries, Guscia, Kirby, Nettelbeck, & Taplin (2005) Hassall, Rose, & McDonald (2005) Hastings, Kovshoff et al. (2005) Hastings, Beck, Daley, & Hill (2005) Howard, Sparkman, Cohen, Green, & Stanislaw (2005) Keen (2005) Kishore, Nizamie, & Nizamie (2005) Klin, Pauls, Schultz, & Volkmar (2005) Lecavalier (2005) Matson, Dixon, Matson, & Logan (2005) Moss et al. (2005) Oliver, Hall, & Murphy (2005) Oliver, Holland, Hall, & Crayton (2005) O'Reilly, Sigafoos, Lancioni, Edrisinha, & Andrews (2005) 1059 children with ID 826 children and adolescents wi 186 children with ID 108 adults with autism 130 individuals with Down sync 82 children with ID or autism 36 individuals with autism or ty development 58 children with Asperger syndr autism, or typical development 615 with ID 1542 adults with ID 98 children with autism, PDD 3 children with autism 83 children with autism, ID, developmental delay, or typical development 80 individuals with ID 46 children with ID 48 children with autism 338 children with ID 61 children with autism, PDD 6 children with autism 60 individuals with ID 65 individuals with Asperger syndrome 284 children with ID or typical development 618 adults with ID 8 children with Cornelia de Lan 16 children with ID or autism 52 individuals with Down syndr 1 adolescent with autism Romski, Sevcik, Adamson, & Bakeman (2005) Sallows & Graupner (2005) Spreat, Conroy, & Fullerton (2005) Stephens, Collins, & Dodder (2005) Veltman et al. (2005) Werner, Dawson, Munson, & Osterling (2005) Williams, Wishart, Pitcairn, & Willis (2005) Yalon-Chamovitz & Greenspan (2005) Zwaigenbaum, Sonnenberg, Heshka, Eastwood, & Xu (2005) Basquill, Nezu, Nezu, & Klein (2004) Beck, Daley, Hastings, & Stevenson (2004) de Bildt et al. (2004) Bradley, Summers, Wood, & Bryson (2004) Eaves & Ho (2004) Graff & Green (2004) Hatton et al. (2004) Kishore, Nizamie, Nizamie, & Jahan (2004) Lecavalier, Aman, Hammer, Stoica, & Matthews (2004) LeGoff (2004) Miller, Fee, & Netterville (2004) Owen et al. (2004) Ozonoffet al. (2004) Paul et al. (2004) Prasher, Farooq, & Holder (2004) Pruchno & McMullen (2004) Rellini, Tortolani, Trillo, Carbone, & Montecchi (2004) Robertson et al. (2004) 33 individuals with ID 24 children with autism 348 adults with ID 2760 adults with ID 1 female with PDD 145 children with autism, developmental delay, or typical development 126 children with ID or Down syndrome 50 adults with ID 1 girl with PDD 45 individuals with ID 33 children with ID 184 children with ID 24 individuals with autism or ID 49 children with autism or PDD 3 children with ID and autism 560 adults with ID 60 individuals with ID 330 children with autism 47 children with autism, Asperge PDD 48 children with ID 93 adults with ID 149 individuals with autism or ty development 40 individuals with autism or PE 150 adults with Down syndrome 831 individuals with ID 65 children with autism, Asperge or PDD 50 individuals with ID Baghdadli, Pascal, Grisi, & Aussilloux (2003) de Bildt et al. (2003) Bosseler & Massaro (2003) Buhrow & Bradley-Johnson (2003) Cohen (2003) Cohen, Schmidt-Lackner, Romanczyk, & Sudhalter (2003) Dube, Mcllvane, Mazzitelli, & McNamara (2003) Fidler (2003) Guralnick, Hammond, & Connor (2003) Guralnick, Neville, Connor, & Hammond (2003) Hall, Thorns, & Oliver (2003) Hatton et al. (2003) Kay et al. (2003) Kottorp, Bernspang, & Fisher (2003) Lam, Giles, & Lavander (2003) Lancioni et al. (2003) Mansell, Beadle-Brown, MacDonald, & Ashman (2003) Mount, Charman, Hastings, Reilly, & Cass (2003) Nachshen, Woodford, & Minnes (2003) Niccols, Atkinson, & Pepler (2003) Oliver, Murphy, Hall, Arron, & Leggett (2003) Orsmond, Seltzer, Kraus, Hong (2003) Ricci & Hodapp (2003) Rogers, Hepburn, & Wehner (2003) 222 children with autism 1059 individuals with ID 14 children with autism 60 children with ID or typical development 84 children with autism 311 children with autism, PDD, CDD, or Asperger syndrome 13 individuals with ID, autism, 36 children with ID or Down syndrome 72 individuals with and without 74 children with ID 8 individuals with developments disabilities 70 children with Fragile X 85 adults with Down syndrome 1724 individuals with ID 47 individuals with ID 3 adults with ID 303 individuals with ID 29 females with Rett syndrome i 106 individuals with Down synd autism, or fragile X 41 children with Down syndron 88 individuals with DD 193 adults with ID 50 individuals with Down syndi or ID 102 individuals with autism, fra£ developmental delay, or typical development Tsatsanis et al. (2003) Urv, Zigman, & Silverman (2003) Van Bourgondien, Reichle, & Schopler (2003) Weiss, Diamond, Demark, & Lovald (2003) Bibby, Eikeseth, Martin, Mudford, & Reeves (2002) Copeland, Hughes, Agran, Wehmeyer, & Fowler (2002) Dekker, Nunn, & Koot (2002) Duker, van Driel, & van de Bercken (2002) Duvdevany (2002) Einam & Cuskelly (2002) Fisch, Simensen, & Schroer (2002) Gonzalez-Gordon, Salvador-Carulla, Romero, Gonzalez-Saiz, & Romero (2002) Grigorenko et al. (2002) Grissom & Borkowski (2002) Gross (2002) Gunter, Ghaziuddin, & Ellis (2002) Guralnick (2002) Hallam et al. (2002) Kravits, Kamps, Kemmerer, & Potucek (2002) Mansell, Ashman, Macdonald, & Beadle-Brown (2002) Mansell, Elliott, Beadle-Brown, Ashman, & Macdonald (2002) syndrome 26 children with autism 529 adults with ID or Down syndrome 32 individuals with autism 97 individuals with ID 66 children with autism 4 adolescents with ID 1057 children with ID 77 individuals with Down syndr< orPWS 31 individuals with ID 50 children with ID or typical development 36 children with autism or Fragi 80 individuals with ID 80 children with developmental d 54 siblings of individuals with II 55 children with autism, ID, developmental delay, or typical development 16 individuals with Asperger syndrome or typical developmen 64 children with ID or Down syndrome 500 individuals with ID 1 girl with autism 495 individuals with ID 49 adults with ID Richards, Williams, & Follette (2002) Rousey, Wild, & Blacher (2002) Smith, Felce, Ahmed et al. (2002) Smith, Felce, Jones, & Lowe (2002) South et al. (2002) Spreat & Conroy (2002) Stancliffe, Hayden, Larson, & Lakin (2002) Wallace, Webb, & Schluter (2002) Zigman, Schupf, Urv, Zigman, & Silverman (2002) Bailey, Hatton, Tassone, Skinner, & Taylor (2001) Balboni, Pedrabissi, Molteni, & Villa (2001) Belser & Sudhalter (2001) Cooper & Browder (2001) Duker, Averink, & Melein (2001) Eikeseth & Jahr (2001) Emerson et al. (2001) Hall, Oliver, & Murphy (2001) Hatton et al. (2001) Jones et al. (2001) Liss et al. (2001) McCarthy & Boyd (2001) Mervis, Klein-Tasman, & Mastin (2001) Miltiades & Pruchno (2001) O'Reilly & Lancioni (2001) Roberts, Mirrett, & Burchinal (2001) Skinner, Correa, Skinner, & Bailey (2001) Sudhalter & Belser (2001) Taubman et al. (2001) Temple, Jozsvai, Konstantareas, & Hewitt (2001) Zarcone et al. (2001) 30 adults with ID 64 children with ID 56 individuals with ID 106 adults with ID 119 children with autism 177 individuals with ID 148 individuals with ID 168 individuals with ID 646 adults with ID 53 males with fragile X 226 individuals with ID 30 individuals with fragile X, au or ID 8 adults with ID 8 children with ID 7 children with autism or typica development 270 individuals with ID 16 children with ID 814 adults with ID 106 individuals with ID 123 children with ID or autism 52 individuals with Down syndi 41 children with Williams syndr 305 individuals with ID 1 boy with Williams syndrome 39 boys with Fragile X syndron 250 children with ID 30 individuals with Fragile X, ai or ID 8 children with ID 35 adults with Down syndrome 20 individuals with ID Fitzgerald et al. (2000) Gillham, Carter, Volkmar, & Sparrow (2000) Keogh, Garnier, Bernheimer, & Gallimore (2000) Laushey & Heflin (2000) Liss, Fein, Bullard, & Robins (2000) Mudford et al. (2000) Oliver, Crayton, Holland, & Hall (2000) Robertson et al. (2000) Smith, Groen, & Wynn (2000) Stancliffe, Abery, & Smith (2000) Verri, Uggetti, Vallero, Ceroni, & Federico (2000) Weber, Egelhoff, McKellop, & Franz (2000) Werner, Dawson, Osterling, & Dinno (2000) Zwaigenbaum et al. (2000) Assumpcao, Santos, Rosario, & Mercadante (1999) Baranek (1999) Coe et al. (1999) Cosgrave, Tyrrell, McCarron, Gill, & Lawlor (1999) Dacey, Nelson, & Stoeckel (1999) Duker (1999) El-Ghoroury & Romanczyk (1999) Freeman, Del'Homme, Guthrie, & Zhang (1999) Hannah & Midlarsky (1999) Hardan & Sahl (1999) Hughes et al. (1999) Jones et al. (1999) 5 individuals with PKU 95 individuals with autism, PDE developmental delay. 80 children with developmental d 2 children with autism 85 individuals with autism, PDE typical development 16 children with autism 49 adults with Down syndrome 500 individuals with ID 28 children with autism or PDD 74 adults with ID 1 adult male with ID 29 individuals with tuberous scle 30 individuals with autism or tyj development 2 boys with autism 3 individuals with autism 32 children with autism, developmental delay, or typical development 88 children with Down syndrom typical development 128 individuals with Down synd 40 adults with ID 126 individuals with ID 9 children with autism 210 children with autism 100 siblings on individuals with '. 233 individuals with ID 24 children with ID or typical development 19 adults with ID Bamburg, & Baglio, (1999) McDermott, Martin, Weinrich, & Kelly (1999) Murphy, Hall, Oliver, & Kissi-Debra (1999) Njardvik, Matson, & Cherry (1999) Rogers et al. (1999) Romski, Sevcik, & Adamson (1999) Sicotte & Stemberger (1999) Stella, Mundy, & Tuchman (1999) Stone, Ousley, Hepburn, Hogan, & Brown (1999) Wall & Gast (1999) Walsh & Shenouda (1999) Zarcone, Crosland, Fisher, Worsdell, & Herman (1999) Ashaye, Fernando, Kohen, Mathew, & Orrell (1998) Bacon, Fein, Morris, Waterhouse, & Allen (1998) Bailey, Mesibov et al. (1998) Bailey, Hatton, & Skinner (1998) Beardsmore, Dorman, Cooper, & Webb (1998) Burt et al. (1998) Carter et al. (1998) Chung (1998) Clare, Gamier, & Gallimore (1998) Clarke, Boer et al. (1998) Dawson, Matson, & Cherry (1998) Dawson, Meltzoff, Osterling, Rinaldi, & Brown (1998) Dykens & Smith (1998) 252 women with ID 614 children with developmenta delay, autism, or typical develop 36 adults with ID 194 children with autism 13 children with ID 28 children with PDD 90 children with autism or PDE 60 individuals with autism or developmental delay 12 adolescents with ID 284 individuals with ID 5 children with ID 144 adults with ID 193 individuals with autism, develpomental delay, ID, and t5 development 57 boys with Fragile X syndrorr 46 boys with Fragile X syndron 23 adults with Prader-Willi sync 70 adults with Down syndrome 684 individuals with autism 1 adolescent female with ID 103 children with developmenta delay 6 individuals with Prader-Willi syndrome 36 adults with autism, PDD, or 59 individuals with autism, Dov syndrome, or typical developme 105 children and adolescents wi Smith-Magenis syndrome or Prader-Willi syndrome Koegel, Camarata, Valdez-Menchaca, Koegel (1998) Lancioni, O'Reilly, Campodonico, & Mantini (1998a) Lancioni, O'Reilly, Campodonico, & Mantini (1998b) Levitas & Reid (1998) Linuma, Minami, Cho, Kajii, & Pachi (1998) Lowe, Felce, Perry, Baxter, & Jones (1998) Matson Carlisle, & Bamburg (1998) Mazzocco, Baumgardner, Freund, & Reiss (1998) Moss et al. (1998) Prasher, Chung, & Haque (1998) Prosser et al. (1998) Rose, Jones, & Fletcher (1998) Spreat, Conroy, & Rice (1998) Stancliffe & Hayden (1998) Stancliffe & Lakin (1998) Turk & Cornish (1998) Udwin, Howlin, Davies, & Mannion (1998) Van Bourgondien, Reichle, Campbell, Mesibov (1998) Zappella, Gillberg, & Ehlers (1998) Borthwick-Duffy, Lane, & Widaman (1997) Boutin et al. (1997) Dykens, Finucane, & Gayley (1997) Field et al. (1997) Horrigan & Barnhill (1997) Jenkins, Rose, & Lovell (1997) Konstantareas & Lunsky (1997) Lord et al. (1997) & 3 children with autism 4 adults with ID 3 women with ID 13 individuals with Rubinstein-1 syndrome 130 individuals with ID or typic. development 41 adults with ID 892 individuals with ID 17 girls with Fragile X syndrome Turner syndrome 201 individuals with ID 128 adults with Down syndrome 68 individuals with ID 24 adults with ID 40 individuals with ID 71 individuals with ID 187 individuals with ID 42 boys with Fragile X, Down syndrome, or typical developmei 70 adults with Williams syndron & 52 adults with autism 30 individuals with autism 67 children with ID 67 individuals with autism or ID 10 individuals with Smith-Mage syndrome 22 children with autism 11 male individuals with autism 39 individuals with ID 31 individuals with autism or developmental delay 319 individuals with autism Seal & Bonvillian (1997) Smith, Eikeseth, Klevstrand, & Lovaas (1997) VanMeter, Fein, Morris, Waterhouse, & Allen (1997) Brinton & Fujiki (1996) Brooke, Collacott, & Bhaumik (1996) Cameron, Luiselli, Littleton, & Ferrelli (1996) Carpentieri & Morgan (1996) Dykens et al. (1996) Ghaziuddin & Gerstein (1996) Koegel, Bimbela, & Schreibman (1996) Lowe, Felce, & Blackman (1996) Luscre & Center (1996) Maaskant et al. (1996) Prasher & Hall (1996) Simon, Rosen, & Ponpipom (1996) Smith & Van Houten (1996) Turner, Realon, Irvin, & Robinson (1996) Waterhouse et al. (1996) 14 adolescents with autism 21 children with ID and PDD children with autism, ID, or typ development 44 individuals with ID 1 individual with ID 1 adolescent female with ID 40 children with autism or ID 29 individuals with Fragile X syndrome 17 individuals with Asperger syndrome 17 children with autism 51 individuals with ID 3 children with autism 1602 adults with ID 201 adults with Down syndromi 86 individuals with ID 15 children with developmental ( or typical development 3 individuals with ID 194 children with autism or PD^ Williams (1996) Wilson, Seaman, & Nettlebeck (1996) Zanolli, Daggett, & Adams (1996) 25 individuals with ID 60 individuals with ID 2 boys with autism ABS—Adaptive Behavior Scale; ABDQ—Adaptive Behavior Derr ADL—Activities of Daily Living; BDI—Battelle Development Invent Development Survey; CDER—Child Development Evaluation Repc Assessment Schedule; DDP—Developmental Disabilities Profile; DDQ Disabilities Quality Assurance Questionnaire; DLSQ—Daily Living DNS—Disability Needs Scale; DP-II—Developmental Profile II; ICAP-and Agency Planning; LDCS—Learning Disability Casemix Scale; Research Council Handicaps, Behavior, and Skills Schedule; OMFAQ—C Functioning Assessment Questionnaire; PDDBI—PDD Behavior Inventc Adaptive Behavior Scales; SIB—Scales of Independent Behavior. as a cnecKnsi uirecuy oy ine miormani. nowever, omy inret studies administered the SIB in a checklist format. The form of the SIB/ICAP used varied among studies with frequently choosing to include the ICAP rather than the SII the breadth of information gathered by the ICAP and the sh tration for adaptive behavior assessment, it is understandabl* would choose this version, particularly if adaptive behavior as central to their research question. However, the shorter adi comes at the cost of less specific and descriptive information th of the SIB-R provides. The primary purpose cited for including any of these a< scales was to provide a measure of general adaptive behavi< terms that researchers used to describe how the scores we: what the scores represented were variable among studie researches cited "overall developmental maturity" (Baran "functional and communication abilities" (Paul et al., 2005 lectual disability" (Hastings, Beck, Daley, & Hill, 2005), or quotient" (Oliver, Hall, & Murphy, 2005) as purposes f< the VABS. Much of this variability is surely due to the fact have multiple uses or that only one aspect of the scale wa respective study (e.g., social skills in Klin, Pauls, Schultz, & However, the numerous definitions of what the scales were ui cited in the identified studies also suggests that there still rem amount of uncertainty or disagreement regarding the consl behavior. Researchers are increasingly using adaptive scales not simj purposes within research studies but also to evaluate diffen behaviors within groups of individuals. As noted previous work has focused on persons with autism. However, it is evi ining Table I that many other diagnostic groups have been e encouraging in that it signifies that researchers have movei evaluating intellectual differences among diagnostic catego: examining differences among adaptive skills (e.g. Hatton et VI. OUINOLUOIUIN Adaptive behavior scales play an important role in help diagnose, plan supports, or determine an individual's level Much research has been conducted to develop specific ; examine the underlying construct that these scales are desi While much progress has been made in this regard, a signi confusion or disagreement still appears to remain regarding construct and the most appropriate way to measure it. The construct of adaptive behavior is fundamental to an> Current definitions of ID (e.g., DSM-IV; AAMR) include a as a component, but place adaptive behavior at different leve In the DSMTV, adaptive behavior is a diagnostic reqi measurement of the construct is only briefly discussed, wh< definition puts a greater weight on the adaptive behavior specifically requires the use of assessment scales standardizec with and without disabilities (Luckasson et al., 2002). While debate may still continue, it is reasonable to concli behavior is a multidimensional construct (Thompson et al., the most widely used adaptive behavior scales continue to composite score in addition to individual domain scoi researchers continue to report a general adaptive score, the 1 to evaluate differences or measure change on the more speci (Paul et al., 2004). There are a number of unique concerns regarding the ps; erties of tests when applied to persons with ID. First, prac consider the manner in which ceiling and basal scores are e: in which ceiling scores are established rapidly may underes dual's abilities in that domain if the skills have develops order. Likewise, establishing a basal too early may overest: It may not be safe to assume that the person is able to perfoi is truly foundational to abilities that have been assessed. A ation when applying adaptive behavior scales to individue muiviuuais irom oiner cultural oacKgrounus is neeueu. A myriad of adaptive scales have been published (Spreat, this review found that researchers over the past 10 years ha> three adaptive behavior scales. The scales identified most fre VABS, the ABS, and the SIB/ICAP. Researchers have m scales to measure participants' general level of adaptive beha1 were less frequently used to establish a diagnosis of ID, as m previous diagnoses that the individuals had received through It is unclear from this chapter the extent to which adaptiv are used by clinicians to develop individual supports for j However, the dearth of research studies reporting the use of a scales to serve this purpose is cause for concern. First, whik report the utility of these scales to serve this purpose, little evi< to indicate how well these scales perform this task. Indeec regarding what information provided by adaptive behavior to the task of maximizing independence. REFERENCES Accardo, P. J., & Capute, A. J. (1998). Mental retardations. 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