When referring to intellectual disability

A currently accepted definition proposes that it is a condition characterized by significant limitations in intellectual functioning and adaptive behavior, the onset of which coincides with the developmental period, consequently affecting intellectual processes such as reasoning, problem-solving, planning, abstract thinking, judgment, and academic learning. Additionally, deficiencies in adaptive behavior are observed, affecting the individual's personal autonomy and social responsibility in various settings and contexts (DSM-V, 2013; AAIDD, 2022).

Intellectual disability in the Panamanian education sector

Intellectual disability is among the most prevalent types of disability in the Panamanian education sector. For example, based on data from the IPHE Statistics Department (2021), of a total of 16,078 students who received some type of support from IPHE teachers in schools nationwide during 2021, at least 9,920 students had intellectual disabilities. This reflects the multiple challenges Panama faces: first, detecting these cases in a timely manner, and second, providing therapeutic and educational support that allows this population group to acquire tools that help them adapt better to the demands of their environment.

Fundamental concepts in intellectual disability

When discussing intellectual disability, two concepts automatically come to mind that are fundamental to understanding in order to provide appropriate support to this population group. First, I refer to intelligence , defined as the capacity people have to act rationally, demonstrate understanding of facts, interact, provide verbal responses appropriate to the situation, solve abstract problems, and show adequate processing ability quickly, efficiently, and with adequate mental control of tasks (Wechsler, 2007; Flanagan & Kaufman, 2012). All of these aspects contribute to a person's ability to learn new content, which is why intelligence is considered an important predictor of academic success. If you wish to deepen your knowledge of intelligence, I recommend reading the following article I authored: Intelligence from the Perspective of Neuropsychology and Education .

The second concept we must consider when discussing intellectual disability is adaptive behavior , a term that refers to the set of skills and abilities necessary for individuals to function optimally at home, at work, at school, and in their community (Oakland & Harrison, 2013). Closely related to adaptive behavior are adaptive skills , which are defined as the set of competencies that help individuals fit into a given role. This, in turn, helps modify behavior according to the demands of the situation (AAMR, 2002). If you would like to deepen your understanding of adaptive behavior, I recommend reading the following article, which I authored: Adaptive Behavior from a Neuropsychological Perspective .

Importance of comprehensive assessment

What does the above tell us? That nowadays, when referring to the concept of intellectual disability, the professional should not only base the diagnosis and severity of the signs and symptoms on the results of intelligence tests, but it is also essential to apply adaptive behavior assessments that help to fully and comprehensively objectify the conclusions of the neuropsychological study.

Standardized tests for assessment and diagnosis

Focusing on the main topic of this article, which is the assessment and diagnosis of intellectual disability, I would like to educate the public about some of the standardized tests used for this purpose. The name of each standardized test is highlighted in blue. This means that if you are interested in learning more about that test, clicking on the link will take you to a tab on my website where you can continue exploring this fascinating topic (each link includes text and a video that you can watch on YouTube).

  • The Wechsler Intelligence Scale for Children and Adolescents (WISC-IV) is a benchmark test for evaluating cognitive indicators that correspond to intelligence. This includes the Verbal Comprehension Index, Perceptual Reasoning Index, Working Memory Index, and Processing Speed Index. Additionally, a complementary test such as the TONI-IV can be useful for evaluating figural problem-solving abilities in the absence of language or cultural influences. This is particularly helpful to assess in patients with language delays or difficulties understanding oral instructions.
  • WPPSI-IV : an ideal test for infants aged 2 years 6 months to 7 years 7 months. It measures cognitive abilities related to verbal comprehension, fluid reasoning, visual processing, working memory, nonverbal intelligence, general abilities, and cognitive competence. From a neurodevelopmental perspective, early detection of any cognitive delay is crucial so that early intervention programs and treatments tailored to the needs of each family and individual case can be implemented.
  • The Adaptive Behavior Assessment System (ABAS-II) is an instrument that allows for the evaluation of adaptive performance in individuals across various contexts and settings. Based on the AAIDD (2002), several characteristics of adaptive behavior are observed in individuals with intellectual disabilities, and these can be detected and analyzed through the application of this test. For example, one benefit of this assessment is that it helps mental health professionals identify areas of strength and weakness within the context of an individual's community, school, or family. This is done by comparing the individual's performance to that of their peers of the same age, allowing for an analysis of how this set of skills may be facilitating or creating obstacles in the process of independence, self-care, and social interactions with others (Harrison & Oakland, 2008).
  • Neuropsychological Maturity (CUMANIN and CUMANES) : Neuropsychological maturity refers to the level of developmental maturation and organization of the Central Nervous System (CNS). This process encompasses multiple mental functions, such as perception, attention, memory, executive functions, and motor skills. If you wish to deepen your knowledge of neuropsychological maturity, I recommend reading the following article: Neuropsychological Maturity and its Importance in Panamanian Education .
  • Psychoeducational testing : It would be useful to assess the patient's level of functioning in reading, writing, and general academic skills (phonological awareness, calculation, mathematical reasoning, etc.). This involves administering reading tests (PROLEC-R and PROLEC-SE-R) , writing tests (PROESC) , and Neuropsychological Batteries focused on the Detection of Learning Difficulties (BANETA) . I would like to clarify that the diagnostic line between an intellectual disability and a learning difficulty is quite thin. In short, if the patient shows indicators of intellectual disability (IQ below the normative group + dysfunction in various adaptive behavioral skills), a possible diagnosis of a learning disorder is automatically ruled out. However, sometimes a patient may demonstrate intelligence and adaptive behavior appropriate for their age and still present learning difficulties. Therefore, the aforementioned tests can be useful when making a possible differential diagnosis of a learning disorder (dyslexia, dyscalculia, dysorthography, or dysgraphia).

Importance of reassessment

Not only is early detection of intellectual disability beneficial, but it is equally important to provide adequate support to patients who, already diagnosed with an intellectual disability, require follow-up through neuropsychological re-evaluations. How does a re-evaluation help? Re-evaluation allows for periodic updates to recommendations for educational institutions, families, and the patient, enabling the implementation of actions aimed at improving the individual's well-being in their various environments.

Why do I say this? For example, patients diagnosed with intellectual disabilities who have completed secondary education may, upon entering university, be asked by the institution to provide an updated report on the student's current situation. This helps the institution provide personalized support based on the student's needs, level of functioning, and expectations. A similar situation may arise when changing schools or after completing one educational stage and beginning another (a new academic year, transition from primary to secondary education, etc.).

Contact information

The Comprehensive Therapeutic Center for Educational Neuropsychology (Neuropsyedu) will be operating in Panama City starting in January 2023, at the Mar del Sur Business Center, just 200 meters from the Vía Argentina Metro Station. To contact us, you can call or text us at +507 65356362, and we will be happy to assist you.

References

  • American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, D.C. (2013). doi:10.1176/appi.books.9780890425596
  • American Association on Intellectual and developmental Disabilities . (2022). Defining criteria for intellectual disability.
  • Echavarría-Ramírez, LM, & Tirapu-Ustárroz, J. (2021). Neuropsychological exploration in children with intellectual disability. Revista de Neurología, 73(2), 66-76.
  • Flanagan, D., & Kaufman, A. (Eds.). (2012). Keys to the WISC-IV Assessment (Second Edition). Mexico: Manual Moderno.
  • IPHE . (2022). Statistical Compendium 2021.
  • Oakland, T., & Harrison, P. (Eds.). (2013). ABAS-II Clinical Use and Interpretation. Madrid, Spain: TEA Ediciones.
  • Wechsler, D. (2007). WISC-IV: Wechsler Intelligence Scale for Children-IV: Technical Manual. Mexico City: El Manual Moderno.