Mental Retardation Determining Eligibility for Social Security Benefits (2002) / Chapter Skim
Currently Skimming:
6. Differential Diagnosis
6. Differential Diagnosis
Pages 245-281
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 245... ...
disability determination specialist to distinguish between mental retardation and other neurodevelopmental and psychiatric disorders with similar signs and symptoms. In addition, when these other disorders are present in addition to mental retardation, they may make assessment of intellectual and adaptive functioning even more complicated than it frequently is.
|
From page 246... ...
However, eligibility for special services in school does not necessarily confer eligibility for SSI benefits. Most individuals with a diagnosis of mental retardation who receive special education services become gainfully employed once they leave the school system.
|
From page 247... ...
Nevertheless, differential diagnosis can be complicated by at least four other factors. First, the severity ancl nature of impairments can vary substantially, with each person having his or her own strengths ancl weaknesses in performance.
|
From page 248... ...
These issues are all reviewed in this chapter, with particular attention to their significance in the context of eligibility for SSI and DI. Eligibility for Support It is sometimes difficult to distinguish between mental retardation and other conditions currently covered by SSI, the so-called categorical disorders: autism, learning disability, borderline intellectual functioning, and organic mental disorders marked by specific behavioral phenotypes.
|
From page 249... ...
Similarly, once eligibility for SSI benefits for individuals with mental retardation is determined, the decision process does not need to consider additional comorbid disorders, and the process of differential diagnosis need not continue further. Differential diagnosis is a different matter for individuals having less severe disabilities that put them at the border of SSI eligibility criteria.
|
From page 250... ...
health and physical well-being (Social Security Administration, 20001. To meet functional equivalence criteria, the child must have either marked impairment (equal to or greater than 2 but less than 3 standard deviations below the mean on a standardized, normreferenced assessment)
|
From page 251... ...
Moreover, although there are systematic differences in the typical adaptive performance of people with mild mental retardation and their peers with more severe degrees of mental retardation, there is also overlap in adaptive behavior skills among people assessed with differing degrees of intellectual disability Janicki & Jacobson, 19821. For example, it is possible for someone with mild mental retardation to have certain adaptive behavioral skills that are less advanced than those of another person with moderate mental retardation.
|
From page 252... ...
Therefore, specific language impairment can be difficult to distinguish from mild mental retardation, as the following case illustrates. Allen is a 3-year-old who has been referred for delayed language development.
|
From page 253... ...
In contrast to the severe constraints on the ability to diagnose mild mental retardation in young children, a great deal is now known about the conditions associated with increased risk for mental retardation. Babies born prematurely, very small for their gestational age, or exposed in utero to alcohol or other teratogenic agents are at increased risk of mental retardation.
|
From page 254... ...
Autism and Pervasive Developmental Disorders John is a 4-year-old with delayed language and socialskills development. Parents report that John is "in his own world' and has limited spontaneous speech, although he frequently repeats back exactly what is said to him.
|
From page 255... ...
Autism differs from mental retardation in that intellectual deficits may or may not be apparent, but social, communication, and behavior disorders are always noted. Difficulties with social interactions include avoidance of eye contact during social activities, difficulty developing peer relations, excessive self-directed play, or avoidance of shared activities.
|
From page 256... ...
Once a diagnosis of autism or mental retardation is made, no further diagnostic information is needed for the disability determination process. Pervasive developmental disorder, not otherwise specified (PDD NOS)
|
From page 257... ...
Cerebral palsy is a disorder of the central nervous system that affects the posture, movement, and muscle tone of the individual. It is caused by a static insult to the brain.
|
From page 258... ...
Differential diagnosis is important for determining eligibility for those individuals whose cerebral palsy is very mild and who have borderline intellectual functioning or mild mental retardation (i.e., fullscale IQs ranging from 60 to 801. The motor deficits may make performance of some tasks on intelligence tests difficult or impossible.
|
From page 259... ...
, Lennox-Gastaut syndrome, and Aicardi syndrome are epilepsy syndromes frequently associated with a high risk for mental retardation. Neonatal seizures are usually associated with central nervous system abnormalities as well as increased risk of mental retardation, cerebral palsy, and epilepsy (Painter & Gaus, 19911.
|
From page 260... ...
, can be expected. However, many individuals with hearing impairment experience developmental delays, and differential diagnosis is necessary to determine whether poor preschool achievement or suspected cognitive impairment is due to mental retardation or to hearing loss.
|
From page 261... ...
While children with visual impairment may have difficulty with abstract concepts, they often do well with numerical computation (Batshaw & Perret, 1992~. As with hearing loss, differential diagnosis is important for determining the underlying reasons for any delays in cognitive development and poor preschool achievement.
|
From page 262... ...
Clinicians and educators typically have access to methods for identifying most complicating conditions; they should therefore be able to determine the factors that are contributing to poor performance in the classroom or during assessments. Nevertheless, disability examiners must now face the task of making differential diagnosis among learning disability, mild mental retardation, attention deficit hyperactivity disorder, borderline intellectual impairment, and SSI-eligible mental retardation.
|
From page 263... ...
It should be noted that the term "mental retardation" has been replaced with "learning disability" throughout Great Britain, and therefore the differential diagnostic terminology is different. Nevertheless, the operational differential diagnostic criteria employed in Great Britain to distinguish specific developmental disorders of speech and language, for example, from learning disability would be comparable to DSM-IV and ICD-10 standards.
|
From page 264... ...
It is tacitly acknowledged in the SSI disability evaluation guidelines, in which reliance on objective evidence and variation in policies regarding special education placement are discussed (Social Security Administration, 20001. It is also illustrated by the substantial variability that exists from state to state in the numbers of school-age children classified with mental retardation (Frankenberger & Fronzaglio, 1991; U.S.
|
From page 265... ...
In any case, she seems to be falling further and further behind her peers, and if she does not qualify for support now, her impairments may meet eligibility criteria in the future. Borderline Intellectual Functioning A substantial number of children experiencing academic difficulties will be found to have composite IQs of 71 to 85 with relatively homogeneous performance profiles consistent with their overall level of intelligence.
|
From page 266... ...
However, it can coexist with another condition (or conditions) and contribute to the performance difficulties of children and adults associated with pervasive developmental disorders, cerebral palsy, or sensory impairment.
|
From page 267... ...
Psychiatric impairment and extreme maladaptive behavior can complicate the diagnosis of mental retardation. There has been little study of the association between risk of specific psychiatric disorders and age in individuals with mental retardation, but later adolescence through young adulthood generally represents a high risk period for many disorders (DSM-IV)
|
From page 268... ...
In addition, it is often difficult to separate the diagnosis of a behavior or mental health disorder from a behavioral characteristic linked to specific genetic (e.g., Prader-Willi syndrome) or nongenetic (e.g., fetal alcohol syndrome)
|
From page 269... ...
Daniel has been diagnosed with mental retardation almost since his first day of school and has been receiving special education services since preschool. The last time Daniel was tested, be had a composite IQ of 72 and was reading at the 2nd-grade level.
|
From page 270... ...
The same conditions that make differential diagnosis of mild mental retardation difficult can have a negative influence on transition, as can maladaptive behavior and psychiatric problems (Blacher, 20011. Ironically, more mildly affected individuals may not receive as much transition programming and preparation for employability as their more severely disabled counterparts because they are in regular classrooms, often struggling with the more traditional academic curriculum (Sitlington, 19961.
|
From page 271... ...
Virtually everyone with more severe mental retardation will have been identified appropriately by the time they reach adulthood. In these cases, differential diagnosis should no longer be an issue for determination of SSI eligibility.
|
From page 272... ...
However, for more mildly affected individuals, there is a reasonable likelihood that they will have received a diagnosis other than mild mental retardation earlier on, and so they will not have established their eligibility for benefits under the mental retardation categorical listing. Especially careful assessment and consideration of functional equivalence will be required of the disability determination specialist to determine the eligibility of such an individual.
|
From page 273... ...
Recent attempts to develop standardized tests of intelligence and adaptive behavior that are not culturally biased are described in Chapters 3 and 4. In developing a differential diagnosis for mental retardation, particularly mild retardation, examiners need to determine whether evident psychopathological conditions are related to a specific cultural process.
|
From page 274... ...
Specific Disorders Associated with Mental Retardation A complete differential diagnosis of mental retardation should address all possible disorders that share similar signs and symptoms with mental retardation. Consideration of the cause of an individual's intellectual disability may be important for treatment and counseling.
|
From page 275... ...
Collectively, these may account for as many as one-third of all cases of mental retardation (Matilainen et al., 1995; Opitz, 19961. Historically, identifiable genetic disorders were thought to cause severe to profound mental retardation, but more recent estimates suggest that 10 to 50 percent of mild mental retardation may also have a specific genetic origin (Rutter et al., 19961.
|
From page 276... ...
Approximately 32 percent of people with the disorder have IQs of 70 or higher. Nevertheless, higher IQ individuals are extremely likely to have poor adaptive behavior and show the same behavioral and food-related vulnerabilities as their peers with lower IQs.
|
From page 277... ...
The case of prenatal alcohol exposure can serve to illustrate this point. Fetal alcohol syndrome and alcohol-related neurodevelopmental disorders result from maternal consumption of alcohol during pregnancy.
|
From page 278... ...
Despite these difficulties, once signs and symptoms are evident and a diagnosis is made, it is likely that fetal alcohol syndrome (or one of the other conditions associated with prenatal alcohol exposure) will be a major contributing factor to substantial difficulties in school achievement, development of social skills, and maintenance of employment.
|
From page 279... ...
Children who have learning disabilities rather than mental retardation have significantly lower academic performance than their peers, but they do not meet criteria for mental retardation i.e., they have composite IQs over 70 and performance difficulties focused in specific domains of cognitive and academic content. Like learning disability in school-age children, borderline intellectual functioning may be differentiated from mental retardation by reviewing cognitive and adaptive functioning evaluations.
|
From page 280... ...
. Social Security Disability Determination Specialists may differentiate individuals with borderline intellectual functioning and learning disability from those with mental retardation by reviewing cognitive and adaptive behavior test results and determining whether the individual meets diagnostic criteria for mental retardation as recommended in Chapters 3 and 4.
|
From page 281... ...
. · Objective data on intellectual and adaptive functioning to determine mental retardation should be collected for individuals with mild neurodevelopmental or psychiatric disabilities who might have impairments that are consistent with or functionally equivalent to mental retardation.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.