In the 1980’s, I was completing my under-graduate degree in psychology at the University of British Columbia. My eldest nephew was born during this time period, and his birth and later diagnosis as an individual with special needs profoundly impacted the direction of my professional life. He was initially recognized as being a “floppy baby” and it was evident that he was not meeting early developmental milestones. My nephew was later diagnosed as having a unique genetic condition, which includes a moderate cognitive delay. He is now an adult who continues to influence my life and I am indebted to him for teaching me patience and helping me to understand what it is like to live as a person with disabilities.
Developmental or cognitive delays are currently referred to by the Diagnostic and Statistical Manual, 5th Edition (DSM-5) as “intellectual disabilities”. The DSM-5 is the reference “bible” used by clinicians, including registered psychologists in Canada, to diagnose and classify mental health conditions including “intellectual disabilities”. The American Psychiatric Association (APA) published the latest version of the DSM-5 in 2013.
Disorder Characteristics
According to the DSM-5:
“Intellectual disability involves impairments of general mental abilities that impact adaptive functioning in three domains, or areas. These domains determine how well an individual copes with everyday tasks:
The conceptual domain includes skills in language, reading, writing, math, reasoning, knowledge, and memory.
The social domain refers to empathy, social judgment, interpersonal communication skills, the ability to make and retain friendships, and similar capacities.
The practical domain centers on self-management in areas such as personal care, job responsibilities, money management, recreation, and organizing school and work tasks.
While intellectual disability does not have a specific age requirement, an individual’s symptoms must begin during the developmental period and are diagnosed based on the severity of deficits in adaptive functioning. The disorder is considered chronic and often co-occurs with other mental conditions like depression, attention-deficit/hyperactivity disorder, and autism spectrum disorder.”
Comprehensive Assessment
The DSM-5 emphasizes the need to use both clinical assessment and standardized testing of intelligence when diagnosing intellectual disability, with the severity of impairment based on adaptive functioning rather than IQ test scores alone. With this latest version of the DSM-5, they have removed IQ test scores from the diagnostic criteria, but still include them in the text description of an intellectual disability. This was done because the American Psychiatric Association (APA) did not want to overemphasize IQ scores as the defining factor of an individual’s overall ability, without adequately considering adaptive functioning levels.
As stated in the DSM-5:
“It is important to note that IQ or similar standardized test scores should still be included in an individual’s assessment. In DSM-5, intellectual disability is considered to be approximately two standard deviations or more below the population, which equals an IQ score of about 70 or below. The assessment of intelligence across three domains (conceptual, social, and practical) will ensure that clinicians base their diagnosis on the impact of the deficit in general mental abilities on functioning needed for everyday life. This is especially important in the development of a treatment plan. The updated criteria will help clinicians develop a fuller, more accurate picture of patients, a critical step in providing them with effective treatment and services.”
References: DSM-5 Intellectual Disability – psychiatry.org
Resources and support available in Alberta
For individuals who meet the diagnostic criteria for an intellectual disability, they will require ongoing support in order to function within society, and to maintain their health and well-being as a semi-independent adult. Family members can access services designed for adults with developmental disabilities, such as:
- Assured Income for the Severely Handicapped (AISH) provides financial assistance to adults with a permanent disability.
- Persons with Developmental Disabilities (PDD) funds employment and recreational programs for adults with developmental disabilities. PDD offers programming to a wide range of adults who have varying degrees of intellectual disability.
Intellectual Disabilities are life-long disabilities and may be a cause of stress when finding employment. Individuals with developmental disabilities may wish to access services provided by Champions Career Centre which works with employers to promote inclusion in the workplace. They also provide employment readiness services.
Champions Career Centre
Suite 650, 839-5th Ave SW, Calgary, AB
403 265 5374