Friday, August 20, 2010

Social Security Admin (SSA) proposes new MR/ID (and other disabilities) eligibility criteria: The potential for major legal confusion

Very interesting new regulations being proposed by the U. S government for a number of disabilities as they relate to eligibility for social security disability (SSA).  Of interest to this blog are the proposed changes in MR/ID.  Below are the major highlights with a few quick comments.  A complete copy of the Federal Register can be found here.  I think a number of professionals (and professional organizations) need to provide feedback to these proposed rules as they introduce some significant inconsistencies between the SSA, AAIDD, and DSM criteria.  Thanks again to the ever vigilant Kevin Foley for sending this information to the ICDP blog.

The proposed ID definition is as follows:

4. Intellectual Disability/Mental Retardation (ID/MR) (12.05)

a. This disorder is defined by significantly subaverage general intellectual functioning with significant deficits in adaptive functioning initially manifested before age 22.

Blogmaster Comment:  AAIDD/DSM specify an onset before the age of 18, and this is what the courts have been following.  This upward extension to age 22 is bound to cause some confusion and debates, especially in legal settings. Since making this original post I learned that SSA has always used age 22--so this is not a change.  I made this clarification in a subsequent post.

b. Signs may include, but are not limited to, poor conceptual, social, and practical, skills, and a tendency to be passive, placid, and dependent on others, or to be impulsive or easily frustrated. When we evaluate your adaptive functioning, we also consider the factors in 12.00F.

c. ID/MR is often demonstrated by evidence from the period before age 22.  However, when we do not have evidence from that period, we will still find that you have ID/MR if we have evidence about your current functioning and the history of your impairment that is consistent with the diagnosis, and there is no evidence to indicate an onset after age 22.

Bogmaster Comment:  IMHO this is a good development in the context of MR/ID cases as often individuals at the upper end of the mild MR category have not been diagnosed with MR/ID during their school years (esp. if they were in school prior to enactment of major federal special education mandates) or, as is the case with some minorities, they were/are given a more politically correct and palatable diagnosis (e.g., LD) when MR/ID may have been the more correct Dx.  Click here for prior post re: the hidden MR/ID individuals who may have not been diagnosed during their school years (the Forrest Gump report and post).

d. We consider your IQ score to be ‘‘valid’’ when it is supported by the other evidence, including objective clinical findings, other clinical observations, and evidence of your day-to-day functioning that is consistent with the test score. If the IQ test provides more than one IQ score (for example, a verbal, performance, and full scale IQ in a Wechsler series test), we use the lowest score. When we consider your IQ score, we apply the rules in 12.00D4.

Bogmaster Comment:  This is both a good and bad rule.  I have previously criticized the latest AAIDD green MR/ID Dx manual for being "stuck on g", with the need for clinical judgment to be allowed in the form of expert clinicians given the clinical freedom to make an MR/ID Dx based on one or more composite or part scores (e.g., Gf and Gc ability scores as per CHC theory), when the validity of the FS IQ is clear.  However, as written, this rule looks like it may open a major can of worms with ANY part/composite score from and IQ battery being able to be used (if lowest) to Dx MR/ID.  This is a major problem as contemporary intelligence tests have evolved to have 5-7 different part scores (esp. as more and more IQ batteries are based on the CHC model), and not all abilities measured by these composites are good proxies of complex cognition and higher abstract reasoning and problem solving, which is typically at the heart of MR/ID Dx.  This is a serious double edged sword---and one I know will be abused....and one that will cause the courts all kinds of confusion if SSA MR/ID Dx is used as evidence for MR/ID Dx in Atkins cases.  Click here for all prior posts that have touched on various issues surrounding the use of part/composite scores.

I urge concerned psychological and MR/ID professionals to provide comments regarding these proposed rules.

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