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Functional Assessment for Adults with Disabilities (2019)

Chapter: Appendix B: Glossary

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Suggested Citation:"Appendix B: Glossary." National Academies of Sciences, Engineering, and Medicine. 2019. Functional Assessment for Adults with Disabilities. Washington, DC: The National Academies Press. doi: 10.17226/25376.
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Suggested Citation:"Appendix B: Glossary." National Academies of Sciences, Engineering, and Medicine. 2019. Functional Assessment for Adults with Disabilities. Washington, DC: The National Academies Press. doi: 10.17226/25376.
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Suggested Citation:"Appendix B: Glossary." National Academies of Sciences, Engineering, and Medicine. 2019. Functional Assessment for Adults with Disabilities. Washington, DC: The National Academies Press. doi: 10.17226/25376.
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Suggested Citation:"Appendix B: Glossary." National Academies of Sciences, Engineering, and Medicine. 2019. Functional Assessment for Adults with Disabilities. Washington, DC: The National Academies Press. doi: 10.17226/25376.
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Suggested Citation:"Appendix B: Glossary." National Academies of Sciences, Engineering, and Medicine. 2019. Functional Assessment for Adults with Disabilities. Washington, DC: The National Academies Press. doi: 10.17226/25376.
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Suggested Citation:"Appendix B: Glossary." National Academies of Sciences, Engineering, and Medicine. 2019. Functional Assessment for Adults with Disabilities. Washington, DC: The National Academies Press. doi: 10.17226/25376.
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Appendix B Glossary Abilities: “enduring attributes of the individual that influence performance” (O*NET, 2019a). Activities: actions or tasks performed by an individual, such as walking, lifting, keyboarding, or problem solving. Activities of daily living: basic tasks of daily life that typically include personal care and hygiene, dressing, feeding, continence management, and mobility. Adaptability: (1) Occupational Requirements Survey definition: “‘Adaptability’ measures characteristics of an occupation that cause a worker to adjust to changes in work routines,” including work tasks, work schedule, and work location (DOL, 2017, p. 61). (2) O*NET definition: “Adaptability/Flexibility— job requires being open to change (positive or negative) and to considerable variety in the workplace” (O*NET, 2019b). (3) U.S. Social Security Administration (SSA) definition: Adapt or manage oneself—“This area of mental functioning refers to the abilities to regulate emotions, control behavior, and maintain well-being in a work setting. Examples include: responding to demands; adapting to changes; managing your psychologically based symptoms; distinguishing between acceptable and unacceptable work performance; setting realistic goals; making plans for yourself independently of others; maintaining personal hygiene and attire appropriate to a work setting; and being aware of normal hazards and taking appropriate precautions” (Mental Disorders Listings Paragraph B Criteria, Paragraph B4 [SSA, n.d.-b]). Body functions: “The physiological functions of body systems, including psychological functions. ‘Body’ refers to the human organism as a whole, and thus includes the brain. Hence, mental (or psychological) functions are subsumed under body functions. The standard for these functions is considered to be the statistical norm for humans” (WHO, 2001, p. 213). Body structures: “The structural or anatomical parts of the body such as organs, limbs and their components classified according to body systems. The standard for these structures is considered to be the statistical norm for humans” (WHO, 2001, p. 213). PREPUBLICATION COPY: UNCORRECTED PROOFS B-1

B-2 FUNCTIONAL ASSESSMENT OF ADULTS WITH DISABILITIES Capability: “the quality or state of being capable”; see also “Abilities” (Merriam-Webster, 2019a). Capacity: “an individual's ability to execute a task or an action” (WHO, 2001, p. 123). Cognitive test: “standardized measure of task performance used to assess cognitive functioning (e.g., intellectual capacity, attention and concentration, processing speed, language and communication, visual-spatial abilities, memory)” (IOM, 2015, p. 223). Disability: (1) International Classification of Functioning, Disability and Health (ICF) definition: “An umbrella term for impairments, activity limitations and participation restrictions. It denotes the negative aspects of the interaction between an individual (with a health condition) and that individual’s contextual factors (environmental and personal factors)” (WHO, 2001, p. 213). (2) SSA definition: In adults, “the inability to engage in any substantial gainful activity…by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months” (SSA, n.d.-a). Executive function: “How well a person can plan, prioritize, organize, sequence, initiate, and execute multi-step procedures” (OIDAP, 2009, p. C-22). Functional limitation: “a loss or restriction of an individual’s ability to perform a specific physical or mental function or activity, such as walking, speaking, memory, and the like” (IOM, 2015, p. 224). Functional severity: “the impact of [a] disorder on and individual’s ability to perform age- appropriate activities, irrespective of illness type and under a broad range of circumstances. … Functional severity reflects the effect of a condition on a final common pathway—ability to conduct daily life” (Stein et al., 1987). Functioning: “an umbrella term encompassing all body functions, activities, and participation” (WHO, 2001, p. 3). Impairment: “A loss or abnormality in body structure or physiological function (including mental functions). Abnormality here is used strictly to refer to a significant variation from established statistical norms (i.e., as a deviation from a population mean within measured standard norms) and should be used only in this sense” (WHO, 2001, p. 213). Instrumental activities of daily living: tasks that are considered to be more complex than “activities of daily living” and relate to independent living in the community, such as navigating transportation options and shopping, preparing meals, managing one’s household, managing finances and medications, communicating with others, and providing companionship and mental support. PREPUBLICATION COPY: UNCORRECTED PROOFS

APPENDIX B B-3 Medically determinable impairment: “A medically determinable physical or mental impairment is an impairment that results from anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable clinical and laboratory diagnostic techniques. The medical evidence must establish that an individual has a physical or mental impairment; a statement about the individual's symptoms is not enough” (SSA, n.d.-a.). Neuropsychological tests: performance-based tests wed to measure various aspects of an individual’s cognitive functioning, including “memory, attention, processing speed, reasoning, judgment, and problem-solving, spatial, and language functions” (Harvey, 2012, p. 91). Noncognitive measure: “standardized self-report measure that assesses noncognitive psychological complaints” (IOM, 2015, p. 224). Participation: “A person’s involvement in a life situation. It represents the societal perspective of functioning” (WHO, 2001, p. 213). Performance: “the execution of an action” (Merriam-Webster, 2019c). Performance validity: the validity of actual ability task performance; often referred to as effort in the literature (Larrabee, 2012, 2014). Performance validity test: “stand-alone or embedded/derived measures used to assess whether an examinee is performing at a level consistent with his/her actual abilities” (IOM, 2015, p. 225; adapted from Larrabee, 2014). Performance-based measure: Requires that the individual being assessed perform a set of functional tasks so that his or her ability to execute them can be ascertained. Examples of such measures include assessments of gait, balance, and lifting in the physical realm and cognition in the mental realm. Psychological assessment: “the comprehensive integration of information from a variety of sources—including formal psychological tests, informal tests and surveys, structured clinical interviews, interviews with others, school and/or medical records, and observational data—to make inferences regarding the mental or behavioral characteristics of an individual or to predict behavior” (IOM, 2015, p. 225; adapted from Hubley and Zumbo, 2013, p. 3). Psychological testing: “the use of formal, standardized procedures for sampling behavior that ensure objective evaluation of the test-taker regardless of who administers the test (Furr and Bacharach, 2013; Hubley and Zumbo, 2013). Major categories of psychological tests include (1) intelligence tests, (2) neuropsychological tests, (3) personality tests, (4) clinical or diagnostic tests (e.g., depression, anxiety), (5) achievement tests, (6) aptitude tests, and (7) occupational or interests tests” (IOM, 2015, p. 225). Psychometrics: “the scientific study, including the development, interpretation, and evaluation, of psychological tests and measures used to assess variability in behavior and link such PREPUBLICATION COPY: UNCORRECTED PROOFS

B-4 FUNCTIONAL ASSESSMENT OF ADULTS WITH DISABILITIES variability to psychological phenomena” (IOM, 2015, p. 225; adapted from Furr and Bacharach, 2013, pp. 9–10; Hubley and Zumbo, 2013, p. 3). Rehabilitation: “the physical restoration of a sick or disabled person by therapeutic measures and reeducation to participation in the activities of a normal life within the limitations of the person’s physical disability”; “the process of restoring an individual to a useful and constructive place in society especially through some form of vocational, correctional, or therapeutic retraining” (Merriam-Webster, 2019b). Reliability: “the consistency of scores across replications of a measurement procedure” (Brennan, 2006, p. 3). Residual functional capacity: “the most [an applicant] can still do despite [his or her impairment-related] limitations” or restrictions on “a regular and continuing basis,” currently defined as 5 days a week, 8 hours a day, or an equivalent work schedule (20 CFR 404.1545; 20 CFR 416.945; SSA, 2017). Response bias: “misrepresentation of abilities in any neuropsychological domain of ability (memory, sensorimotor, language, etc.) through performance, or self-report regarding performance capabilities” (Heilbronner et al., 2009, p. 1100). Self-report measure: “standardized instruments that rely on self-report with population-based normative data that allow the examiner to compare an individual’s reported behaviors or symptoms with an appropriate comparison group” (IOM, 2015, p. 225). Self-report of symptoms: an individual’s “own description of [his or her] physical or mental impairment” (20 CFR § 404.1528). Sensory processing: “the way the nervous system receives messages from the senses and turns them into appropriate motor and behavioral responses” (STAR Institute, 2018). Substantial gainful activity (SGA): “work that—(a) involves doing significant and productive physical or mental duties; and (b) is done (or intended) for pay or profit” (20 CFR 404.1510). The monthly SGA amount for non-blind individuals in 2019 is $1,220 after deducting impairment related work expenses (SSA, 2019). Symptom validity: “the accuracy of symptomatic complaint on self-report measures” (Larrabee, 2012, p. 2; see also Larrabee, 2014). Symptom validity test: “embedded or stand-alone measures used to assess whether an examinee is providing an accurate report of his or her actual symptom experience on non-cognitive psychological measures (e.g., emotional, behavioral, and personality measures)” (IOM, 2015, p. 226; adapted from Larrabee, 2014). Task: a set of mental and physical activities in which an individual engages to accomplish a specific goal at or by a specific time. PREPUBLICATION COPY: UNCORRECTED PROOFS

APPENDIX B B-5 Validity: “the degree to which evidence and theory support the interpretations of test scores for proposed uses of tests” (AERA et al., 2014, p. 11). REFERENCES AERA, APA, and NCME (American Educational Research Association, American Psychology Association, and National Council on Measurement in Education). 2014. Standards for educational and psychological testing. Washington, DC: AERA. Brennan, R. L. 2006. Perspectives on the evolution and future of educational measurement. In Educational measurement, fourth edition, edited by R. L. Brennan. Westport, CT: Praeger Publishers. Pp. 1-16. DOL (U.S. Department of Labor). 2017. Occupational Requirements Survey (ORS): Collection manual, 3rd edition. Washington, DC: Bureau of Labor Statistics. https://www.bls.gov/ors/about/information- for-survey-participants/pdf/occupational-requirements-survey-collection-manual-072017.pdf (April 10, 2019). Furr, R. M., and V. R. Bacharach. 2014. Psychometrics: An introduction. 2nd. edition. Thousand Oaks, CA: Sage Publications, Inc. Harvey, P. D. 2012. Clinical applications of neuropsychological assessment. Dialogues in Clinical Neuroscience 14(1):91–99. Heilbronner, R. L., J. J. Sweet, J. E. Morgan, G. J. Larrabee, S. R. Millis, and Conference participants. 2009. American Academy of Clinical Neuropsychology consensus conference statement on the neuropsychological assessment of effort, response bias, and malingering. The Clinical Neuropsychologist 23(7):1093–1129. Hubley, A. M., and B. D. Zumbo. 2013. Psychometric characteristics of assessment procedures: An overview. In APA handbook of testing and assessment in psychology: Vol. 1 Test theory and testing and assessment in industrial and organizational psychology, edited by K. F. Geisinger (editor-in- chief) and B. A. Bracken, J. F. Carlson, J. C. Hansen, N. R. Kuncel, S. P. Reise, and M. C. Rodriguez (associate editors). Washington, DC: American Psychological Association. Pp. 3–19. IOM (Institute of Medicine). 2015. Psychological testing in the service of disability determination. Washington, DC: The National Academies Press. Larrabee, G. J. 2012. Performance validity and symptom validity in neuropsychological assessment. Journal of the International Neuropsychological Society 18(4):625–630. Larrabee, G. J. 2014. Performance and Symptom Validity. Presentation to Committee on Psychological Testing, Including Validity Testing, for Social Security Administration Disability Determinations, June 25, 2014, Washington, DC. Merriam-Webster. 2019a. Capability. https://www.merriam-webster.com/dictionary/capability (accessed April 10, 2019). Merriam-Webster. 2019b. Medical definition of rehabilitation. Merriam-Webster Dictionary [online]. https://www.merriam-webster.com/dictionary/rehabilitation (accessed April 10, 2019). Merriam-Webster. 2019c. Performance. https://www.merriam-webster.com/dictionary/performance (accessed April 10, 2019). OIDAP (Occupational Information Development Advisory Panel). 2009. Mental cognitive subcommittee: Content model and classification recommendations. https://www.ssa.gov/oidap/Documents/AppendixC.pdf (accessed April 10, 2019). O*NET. 2019a. The O*Net Content Model. https://www.onetcenter.org/content.html (accessed April 25, 2019) O*NET. 2019b. Work styles. https://www.onetonline.org/find/descriptor/browse/Work_Styles (accessed April 10, 2019). SSA (U.S. Social Security Administration). 2012. DI 00115.015 Definitions of disability. https://secure.ssa.gov/poms.nsf/lnx/0400115015 (accessed April 10, 2019). PREPUBLICATION COPY: UNCORRECTED PROOFS

B-6 FUNCTIONAL ASSESSMENT OF ADULTS WITH DISABILITIES SSA. 2017. Adult functional assessment in Social Security disability claims. Presentation to the Committee on Functional Assessment for Adults with Disabilities, December 7, Washington, DC. SSA. 2019. Substantial gainful activity. https://www.ssa.gov/oact/cola/sga.html (accessed March 7, 2019). SSA. n.d.-a. Disability evaluation under Social Security; Part I—General information. http://www.ssa.gov/disability/professionals/bluebook/general-info.htm (accessed April 10, 2019). SSA. n.d.-b. Disability evaluation under Social Security: 12.00 Mental disorders adult. https://www.ssa.gov/disability/professionals/bluebook/12.00-MentalDisorders-Adult.htm (accessed April 10, 2019). STAR Institute. 2018. About SPD. https://www.spdstar.org/basic/about-spd (accessed April 10, 2019). Stein, R. E. K., S. L. Gortmaker, E. C. Perrin, J. M. Perrin, I. B. Pless, D. K. Walker, and M. Weitzman. 1987. Severity of illness: Concepts and measurements. Lancet 2(8574):1506–1509. WHO (World Health Organization). 2001. International Classification of Functioning, Disability and Health (ICF). Geneva, Switzerland: WHO. PREPUBLICATION COPY: UNCORRECTED PROOFS

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The U.S. Social Security Administration (SSA) provides disability benefits through the Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs. To receive SSDI or SSI disability benefits, an individual must meet the statutory definition of disability, which is “the inability to engage in any substantial gainful activity [SGA] by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.” SSA uses a five-step sequential process to determine whether an adult applicant meets this definition.

Functional Assessment for Adults with Disabilities examines ways to collect information about an individual’s physical and mental (cognitive and noncognitive) functional abilities relevant to work requirements. This report discusses the types of information that support findings of limitations in functional abilities relevant to work requirements, and provides findings and conclusions regarding the collection of information and assessment of functional abilities relevant to work requirements.

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