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What is Intellectual Disability? How

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Article in International Journal of Disability Development and Education September
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DOI: 10.1080/1034912X.2011.598675

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What is Intellectual Disability? How is it

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Trevor R. Parmenter

Sydney School of Medicine, University of Sydney, Sydney, New

South Wales, Australia
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International Journal of Disability, Development and Education

Vol. 58, No. 3, September 2011, 303319

REVIEW ESSAY

What is Intellectual Disability? How is it Assessed and Classied?

Trevor R. Parmenter*

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Sydney School of Medicine, University of Sydney, Sydney, New South Wales, Australia

Intellectual disability. Denition, classication, and systems of support (11th ed.),

edited by R. L. Schalock, S. A. Borthwick-Duffy, V. J. Bradley, W. H. E. Buntinx,
D. L. Coulter, E. M. Craig, et al., 2010, Washington, DC, American Association on
Intellectual and Developmental Disabilities, 254 pp. + index, AUS$90.00 (hardback),
ISBN 978-1-93-530404-3
People with an intellectual disability have existed across human history, making up a
part of all cultures. They represent a small part of the extremely wide variety of people
in the human population at any one time. Ivan Brown commented:
Although it is sometimes useful for us to describe them as groups for various positive purposes, they are not distinct groups of people at all; rather they are individuals who each
add one piece to the mosaic that illustrates the rich, interesting diversity that is characteristic of the human condition. (2007, p. 3)

This review essay will examine the 11th and latest Denition and Classication
Manual published by the American Association on Intellectual and Developmental Disabilities (AAIDD) (Schalock et al., 2010) in the context of historical and contemporary
trends in the denition and classication of intelligence; or more accurately intellectual
functioning.
Terminology
There have been many changes in the way people with an intellectual disability have
been named and categorised. Terms formerly used such as idiot, imbecile, feebleminded,
mentally subnormal, moron, mentally decient and retard are now seen as highly
pejorative and stigmatising, although at the time of their use they were acceptable terms
in the scientic literature. Likewise, organisations have responded to use more contemporary acceptable language. Examples are the AAIDD (formerly the American
Association on Mental Retardation and, earlier, the American Association on Mental
Deciency), the International Association for the Scientic Study of Intellectual
Disabilities (also, formerly Mental Deciency) and Inclusion International (formerly
International League of Societies for Persons with a Mental Handicap).

*Email: trevor.parmenter@sydney.edu.au
ISSN 1034-912X print/ISSN 1465-346X online
2011 Taylor & Francis
DOI: 10.1080/1034912X.2011.598675
http://www.informaworld.com

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Brown (2007) distinguished between the literal, denitional and social meanings of
terms. He suggested that the literal meaning is the simplest and broadest understanding
of a term. Therefore, intellectual disability in the literal sense refers to some restriction
or lack of ability having to do with human intellect (Brown, 2007, p. 3). But at times
there may be a need to adopt a more specic denitional meaning; examples being the
way professional or policy planners may choose to dene the condition in different
ways. These may vary across disciplines and/or across countries. For example, the
World Health Organisation (WHO), the American Psychiatric Association and the
AAIDD each has different denitions of intellectual disability.
Finally, changing social values and attitudes may impact both the literal and denitional meanings. For instance the term mental retardation came to be seen as a derogatory term and has been gradually replaced by the term intellectual disability in many
parts of the English-speaking world. In the United Kingdom, the terms learning disability or learning difculty, which have both social and denitional qualities, are
used. In Canada, intellectual disability and developmental disability are used synonymously; whereas in the United States the latter term encompasses conditions such as
cerebral palsy and Aspergers syndrome, where there is not necessarily an intellectual
disability.
Eminent researchers from a psychology background such as Ellis in the United
States commented that mental retardation was a social problem (1963, p. xi), and
Clarke and Clarke in the United Kingdom suggested that: mental deciency is a social
administrative rather than a scientic concept, varying in different countries and within
a given country at different times (1958, p. xiv).
Self-advocacy groups, representing people with intellectual disabilities, have become
very instrumental in changing the way language is used to refer to the condition, arguing that the terms used demean them because of the implicit negative connotations.
Even the term disability implies a condition less than normal.
It is acknowledged that all categories of disabilities have experienced discrimination
and stigmatisation throughout the millennia, but an intact intellect has historically been
highly valued and often seen as the essential characteristic of being fully human
(Parmenter, 2001). In his presidential address to the First Congress of the International
Association for the Scientic Study of Intellectual Disabilities, Harvey Stevens (1967,
p. xxxii) commented that in the not-too-distant past the person with an intellectual disability, was viewed not as a second-class citizen but, rather, as one who possessed no
citizenship.
Whilst the term intellectual disability has been accepted as a replacement for
mental retardation by the AAIDD and the Presidents Committee on Intellectual Disability in the United States, organisations such as the WHO have reservations concerning the inclusion of the term disability in the nomenclature of the condition,
especially for incorporation within the International Classication of Diseases.
Salvador-Carulla and Bertelli (2008, p. 12) argued, . . . it is time to admit that the
stigma of early cognitive impairment is not in the term we use but in the construct
itself. They further suggested that intellectual disability should not be regarded as a
disease or a disability, but rather . . . as a syndrome grouping (metasyndrome) similar
to the construct of dementia (Salvador-Carulla & Bertelli, 2008, p. 16). As an alternative to intellectual disability or mental retardation, they suggested the term developmental cognitive impairment. It would appear that until we have a more inclusive
society with a deeper respect for diversity of the human condition, stigmatisation will
be evident irrespective of terminology.

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Assessment and Classication

In the nineteenth and early twentieth centuries, educational approaches to training persons with an intellectual disability were inuenced by the rising discipline of psychology. Theories propounded by Francis Galton (18221911), William James (18421910),
Arnold Gessell (18801961), Charles Spearman (18631945), Cyril Burt (18831971)
and Jean Piaget (18961979) had a signicant effect upon the way people with an intellectual disability came to be assessed and classied. Early scientic attempts to diagnose or explain the phenomena of low intelligence included Galens (Evans, 1945)
reference to the associations between idiocy and large ears, and palmistry and phrenology. Other movements included: polygenism, which emphasised that among the human
races there were separate biological species; craniometry, the measurement of skulls;
and the measurement of bodies to search for signs of apish morphology in groups that
were deemed to be undesirable.
However, it was Alfred Binet (18571911), the director of the psychology laboratory at the Sorbonne in Paris, who is credited with the development of the rst scale to
measure intelligence. Binets motives for the development of a scale were prompted
by the need to identify those children whose lack of success in regular classrooms may
have required a special education programme to remedy their difculties.
The American psychologist Lewis M. Terman (18771956), Professor at Stanford
University, built upon Binets early work, renaming the scale the StanfordBinet Test of
Intelligence (Terman, 1916). Terman, strongly inuenced by the burgeoning eugenics
movement of the late nineteenth and early twentieth centuries, emphasised the danger
that high grade defectives presented to society. His commitment to the value of mass
intelligence testing is reected in his comment that:
. . . it is safe to predict that in the near future intelligence tests will bring thousands of these
high grade defectives under the surveillance and protection of society. This will ultimately
result in curtailing the reproduction of feeble-mindedness, and in the elimination of an
enormous amount of crime, pauperism, and industrial inefciency. (Terman, 1916, pp. 67)

A combination of the impact of the publication in 1859 of Charles Darwins (1859)

Origin of the Species and the genetic discoveries of Gregor Mendel (18221884) reinforced the view that intellectual disability was a single inheritable condition, and not
one that can be due to a variety of genetics and other causes. Eugenics societies sprang
up over much of the western world, with pressure being placed upon parents of people
with an intellectual disability to discourage their marriage and procreation. Arbitrary
sterilisation laws, some only recently repealed, were enacted in many countries, including Canada, the United States, Sweden and France.
The net effect of the eugenics movement was a rapid increase in the numbers of people who were institutionalised across the western world, ostensibly to
protect society from the dangers predicted by Terman and other inuential
advocates.
From the mid-twentieth century onwards a number of signicant advances were
made in the denition and classication of intellectual disabilities (Parmenter, 2004).
These were to a large extent inuenced by at least three factors. First, the results of
research, from both operant and cognitive psychological perspectives, demonstrated the
learning potential of people with an intellectual disability. Second, the proclamation by
the United Nations in 1971 of the Declaration of the Rights of Mentally Retarded Persons (United Nations, 1971) provided an impetus for countries to re-examine their laws

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to ensure that the rights of people with an intellectual disability were being safeguarded.
Third, the growing de-institutionalisation movement in several western countries provided a spirit of optimism that challenged commonly held beliefs about the moral status
of persons with an intellectual disability.

The Role of the AAIDD in the Denition and Classication of Intellectual Disability
Since 1921 the AAIDD has published denitions of intellectual disability. The fourth
and fth revisions edited by Heber (1959, 1961) signicantly included impairments in
adaptive behaviour in addition to sub-average general intellectual functioning, which
was the main factor in earlier editions. This new denition, linked with the optimism of
new pedagogical techniques, supported the proposition that the effects of intellectual
disability could be reversed or ameliorated. It is signicant that the Terminology and
Classication (T&C) Committees of AAIDD from this time onwards have been wrestling with the denition of the concept of intellectual disability. For instance, in the
fourth edition the denition stated:
Mental Retardation refers to sub-average intellectual functioning which originates in the
developmental period and is associated with impairment in one or more of the following
(1) maturation, (2) learning and (3) social adjustment. (Heber, 1959, p. 3)

The next signicant development occurred with the publication of the Ninth Edition
in 1992 (Luckasson et al., 1992), where the traditional classication system linked to
intelligence quotient (IQ) levels (i.e., mild, moderate, severe and profound) was
replaced by the concept of levels of intensity of support. This development represented
a signicant paradigm shift in the way intellectual disability was conceptualised. It was
not seen as an absolute trait expressed solely by an individual. The reformulated denition and the accompanying classication of supports acknowledged that the disability
resulted from the interaction of the person with his or her environment. This development was also consistent with the emerging strength of the social, as opposed to the
medical, model of disability (Mercer, 1992). This approach met strenuous opposition,
particularly from sections of the psychological community. For instance, MacMillan,
Gresham, and Siperstein (1995, p. 87) described the new paradigm as advocacy versus
precision, while Baumeister (2006, p. 95) suggested the new approach was confusing
sentiment with science.
Subsequent revisions (Luckasson et al., 2002; Schalock et al., 2010) have further developed the concept of intellectual disability, the conceptualisation and planning of individualised supports and the measurement of adaptive behaviour
(Schalock, 1999). Throughout these recent revisions there has been a deeper appreciation of the relationship between the AAIDD approach to denition and classication of intellectual disability and that of other relevant international classication
systems such as the Diagnostic and Statistical Manual of Mental Disorders (DSMIV) (American Psychiatric Association, 2000), International Classication of Diseases
(World Health Organization, 1999), and the International Classication of Functioning, Disability and Health (ICF) (World Health Organization, 2001). For a detailed
review of the Manuals published in the period 19612002, refer to Greenspan and
Switzky (2006).
The 11th editions denition, in essence, has not been changed since the publication
of the fourth and fth editions:

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Intellectual disability is characterised by signicant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social and practical adaptive
skills. This disability originates before age 18. (Schalock et al., 2010, p. 5)

The growth of the IQ testing movement throughout the twentieth century within
western industrialised countries has been heavily inuenced by social, political and economic forces, peculiar to the perceived needs of an industrialised economy. A more
anthropological approach, as described by Cianciolo and Sternberg (2004, p. 22), suggested that: . . . people in different cultures may develop somewhat different intellectual abilities, depending on what types of intellectual competence are valued in their
particular culture.
In fact, Sternberg and Grigorenko (1997) did not consider that intelligence is a construct that can be easily separable from the construct of adaptive behaviour, a view also
canvassed by Schalock (2004). It has long been recognised that the development of
cognitive function is an interaction between hereditary and environmental factors (Berry,
2004). Sternberg (1999) dened successful intelligence as, . . . the balancing of analytical, creative and practical abilities to achieve success within a particular sociocultural
context (cited in Cianciolo & Sternberg, 2004, p. 27).
Competence and ones ability to navigate effectively within a culture depend very
much upon the environmental contexts of that culture. Emerson, Fugiura, and Hatton
suggested that:
. . . most societies seem to construct competence in more socially and culturally situated
terms, rather than an abstract conception of intelligence, with substantial diversity in these
constructions according to the specic needs and cultural mores of different cultural groups
. . . from a global context the provision of classication systems and services based on conceptions of intellectual disability may be misguided; classication systems and services
starting from local conceptions of competence and the proper social role of a competent
person may be more productive. (2007, p. 607)

In summary, there is strong evidence that socio-cultural factors largely determine

what is seen as competent behaviour. Within western high-income countries, driven by
the values of utilitarian individualism, the construct of intellectual disability has been
largely determined to meet the needs of urban, industrialised societies. In contrast, competence in non-industrialised societies may be more reected in collaborative, interpersonal problem-solving skills such as those found among Nigerian students labelled as
intellectually disabled (Edeh & Hickson, 2002).
However, as Emerson et al. (2007) pointed out, people who are judged to be incompetent or obtrusive in countries decient in support services are often neglected and
consigned to a life in poorly managed segregated institutions, as is the case in China,
Russia and some countries in Eastern Europe. Non-western countries that have a long
history of a globalised economy, such as Taiwan and Japan, also remain committed to
segregated institutional provisions for people with an intellectual disability (Chou &
Schalock, 2007), despite a notional acceptance of inclusionary policies enunciated by
the United Nations Declarations and Conventions. Even high-income countries such as
Australia and the United States have not been able to close fully congregate care facilities catering for people with very high support needs, despite decades of enlightened
disability and anti-discrimination legislation.
It is paradoxical that better healthcare for people with intellectual disabilities, leading to a much longer life expectation and a burgeoning of older people at risk, is raising

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the spectre of re-institutionalisation of this population as support services seem unable

to meet the challenges of the principle of ageing in places (Parmenter, 2010).
Support Needs Framework
In the planning and delivery of educational and vocational programmes for people with
an intellectual disability, the benets of a support needs approach to classication, in
contrast to the earlier practice of classication based upon IQ levels (i.e., mild, moderate, severe and profound), are signicant. First, it calls for a personal and individualised
approach to service delivery which meets the individual support needs of that person.
Rigid stereotypes concerning the behaviours and needs of persons within a specic IQ
band fail to predict the needs of an individual. Nor does this approach t comfortably
with the social (Goodley, 2001; Shakespeare & Watson, 2001) and rights (Rioux, 1994;
Rioux, Lindqvist, & Carbert, 2007) models of disability where environmental factors
must be taken into consideration. For instance, rather than addressing a persons particular cognitive impairment, it may be more effective to make an accommodation to the
persons environment by the provision of a support that ameliorates the impact of the
impairment. Support needs assessment instruments that assess a persons needs across a
range of everyday life domains, including health, are now available (cf. Riches,
Parmenter, Llewellyn, Hindmarsh, & Chen, 2009a, 2009b; Thompson et al., 2004).
A support needs framework has certainly provided a more effective approach to
meeting the functional needs of a person diagnosed as having an intellectual disability
than earlier attempts to improve functioning through an aptitude-treatment approach.
This technique, popular in the 1970s and 1980s, attempted to maximise a persons
learning capabilities with interventions based upon the persons cognitive prole, as
assessed by psychological testing. Research has consistently shown this approach to be
of very limited value (Ysseldyke & Mirkin, 1982).
Research has shown that intellectual disability is not a unitary, but a multi-faceted
phenomenon. People with an intellectual disability generally have what are described in
the literature as co-morbidities. That is, they frequently experience multiple impairments, which often include complex health problems (Beange, Lennox, & Parmenter,
1999). They also experience much higher levels of mental health disorders than the
general population (Einfeld et al., 2006; Hofer et al., 2009). These co-existing disabilities are particularly likely to be problems of agility, mobility, speech and language; and
emotional problems including anger control, anxiety and depression. They are also more
likely to experience loneliness and lack of friends (McVilly, Parmenter, Stancliffe, &
Burton-Smith, 2004).
Development of the 11th Edition of the Manual
In its development of the 11th edition of the Manual, the T&C Committee of the
AAIDD embarked upon two major activities. The rst was a detailed analysis of the
reviews and critiques of the 2002 Manual. The second was the publishing, over a twoyear period, of a series of articles in Intellectual and Developmental Disabilities
addressing issues such as: terminology and denition of intellectual disability; the intellectual disability construct and its relationship to human functioning; conceptualisation
of supports and support needs; the characteristics of people with intellectual disability
who have higher IQ scores; and public policy issues. Input from readers of these articles helped inform the Committees deliberations.

What is Intellectual Disability?

309

The Manual is organised into four parts: understanding intellectual disability and its
assessment; diagnosis and classication of intellectual disability; systems of supports;
and implications for public policy, education and support provider organisations.
As indicated above, the current denition retains what are referred to as the three
essential elements of intellectual disabilitylimitations in intellectual functioning,
behavioural limitations in adapting to environmental demands and early age of onset.
At this stage I wish to address a number of issues in the current Manual, some of which
I perceive as positive advances in the support of people with intellectual disabilities,
and some which I believe are still problematic.

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Aetiologic Risk Factors

Fortunately, we have emerged from the period when a discussion of the aetiology of
intellectual disability was seen as a vestige of the much-maligned medical model of
disability. Therefore, it is refreshing that the current edition builds upon the approach to
aetiology described in the two previous American Association on Mental Retardation
manuals (Luckasson et al., 1992, 2002). It is proposed that a multi-factorial construct
composed of four risk factors (biomedical, social, behavioural, and educational) builds
upon the earlier approaches that organised the aetiology of intellectual disability into
two broad types: intellectual disability of biological origin or due to psychosocial disadvantage (Grossman, 1983). The current discussion notes that in real life the two-group
distinction oversimplies the picture because, for instance, biomedical risk factors may
be present in people with intellectual disability of a culturalfamilial origin. The reverse
may also be the case. Chapter Six contains a very useful table reecting the two-way
direction of causal factors: the types and the timing of the factors.
The timing across prenatal, perinatal and postnatal periods raises the issue of the
third criterion of the denition of intellectual disability; namely, the age of onset being
during the developmental period (i.e., before age 18). It is appreciated that intellectual
disability lies within the broader category of developmental disabilities, but the selection
of age 18 does appear to be arbitrary, a position supported by Salvador-Carulla and
Bertelli (2008). It would exclude, for instance, a person who contracted either a
traumatic brain injury or an illness such as meningoencephalitus at age 19, both of
which may permanently affect cognitive functioning. Nowhere is the developmental
period scientically dened. This issue resonates with the view expressed by Clarke
and Clarke (1958) above, when they suggested that the term intellectual disability was
more an administrative than a scientic concept.
There is a very useful discussion on aetiology and performance, with both positive
and negative aspects canvassed. For instance, the multi-factorial approach, including
biomedical risk factors, allows one to identify all the risk factors that may contribute to
an individuals present functioning. This helps support services to identify strategies for
supporting the person and his or her family that will prevent or ameliorate the risk factors. In the discussion of the genotypephenotype correlation there is a pertinent warning that etiology is not destiny (Schalock et al., 2010, p. 70), as genotypic expression
may be modied by many other factors. It is pointed out, however, that there is strong
evidence for behavioural phenotypes being associated with a number of aetiologic diagnoses. This is an area of very active research, the results of which need to be considered within the multi-factorial construct. For example, Smith, Dykens, and Greenberg
(1998), in their longitudinal study of people with SmithMagenis syndrome, provided
important information on the behavioural aspects of SmithMagenis syndrome. The

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Society for the Study of Behavioural Phenotypes has conducted annual international
conferences since 1999, one of its goals being to encourage collaboration between clinicians and researchers in studying behavioural phenotypes (http://www.ssbp.org.uk/site/
index.php).
Assessment of Limitations in Intellectual Functioning
Throughout the various editions of the AAIDD Manuals there have been differing positions concerning the cut-off points for levels of IQ, highlighting the impact public policy has upon the determination of the size of the population identied as having an
intellectual disability. The 1961 edition dened the term subaverage as performance
which is greater than one Standard Deviation below the mean of the age group involved
on measures of intellectual functioning (Heber, 1961, p. 3). This led to the creation of
a borderline category with an IQ ceiling of 85, resulting in an over-representation of
minority groups in special education classrooms in the United States. As a reaction to
this state of affairs, the 1973 Manual changed the denition from subaverage general
intellectual functioning (Heber, 1961, p. 3) to signicantly subaverage general intellectual functioning (Grossman, 1973, p. 5), thus specifying a greater severity of intellectual impairment (Grossman, 1973). The upper level of intellectual disability was
changed from minus one standard deviation (SD) on the Wechsler Scales (Wechsler,
1991) to minus two SDs, thus eliminating the borderline category.
Another signicant change that related to the need to also incorporate measures of
adaptive behaviour adopted in the 1961 denition was the change of wording from
subaverage intellectual functioning is associated with impairments in adaptive behaviour (Heber, 1961, p. 3) to existing concurrently with decits in adaptive behaviour
(Grossman, 1973, p. 5). It took some time, however, for the assessment of adaptive
behaviours to become standard practice in the assessment processes, despite the guidelines in the respective manuals; driven in my view by the primacy of the IQ score.
As a reaction to the restriction of upper level of IQ to a cut-off point of an IQ score
of less than 70, the 1983 edition emphasised the need to take into account an IQ tests
standard error of measurement, and encouraged the greater use of clinical judgement in
the diagnostic process (Grossman, 1983). These issues have been taken up in later editions. As noted earlier, the 1992 edition made a paradigmatic shift, not only in its reconceptualisation of the disabling process as a result of the interaction of the person
with their environment, but also in the change of the classication system from IQ levels to the levels of intensity and patterns of supports needed by the individual. Whilst
this edition maintained the operational denition of an IQ score approximately two SDs
or more below the population mean, the criterion was established more loosely, as a
score of 70 to 75 or below (Luckasson et al., 1992, p. 14). Greenspan and Switzky
(2006, p. 17) suggested that this reected the T&C Committees, . . . frustration over
the continuing tendency of professionals and agencies to apply the 70 IQ ceiling inexibly, without taking into account either the standard error or adaptive functioning level.
Given the pressure to appear objective and scientic, it is little wonder that the
research community and governments responsible for the provision of nancial support
to people with intellectual disabilities, needed to have an inexible eligibility criterion.
The 2002 edition (Luckasson et al., 2002) returned to the 1983 position to take the
SD of a scale into account, thereby implying that a score of 75 could make one eligible.
The role of clinical judgement in the selection of tests and the interpretation of test
scores were again stressed. There was also detailed discussion in the 2002 edition

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regarding the over-reliance upon IQ test scores in reaching a diagnosis. Despite the
attempt to raise the prole of the results of tests of adaptive behaviours to an equal
standing with IQ test scores, the Manual stated that subaverage intellectual functioning
. . . is a necessary but insufcient criterion to establish a diagnosis of mental retardation (Luckasson et al., 2002, p. 66). This implies maintenance of the one-way diagnostic process, with IQ scores remaining the rst criterion to be met.
The current edition reafrms the position taken in the 2002 Manual concerning the
importance of clinical judgement. It states:
The intent of this denition is not to specify hard and fast cut-off point/score for meeting
the signicant limitations in intellectual functioning of Intellectual Disability. Rather, one
needs to use clinical judgement in interpreting the obtained score in reference to the tests
standard error of measurement, the assessment instruments strengths and limitations, and
other factors such as practice effects, fatigue effects, and the age of norms used. (Schalock
et al., 2010, p. 35)

This edition warns that the diagnostic decision-making process ought not to be seen as
only a statistical calculation. I would argue that it may take some years for the mindset of
support and/or funding agencies to accommodate the theoretical arguments outlined
above. Administrators charged with the curtailment of expenditures on disability support
services prefer a clear and unambiguous metric to determine eligibility for resource
allocation.
In recent years I was involved in convincing the International Paralympic Committee that clear mechanisms existed to determine the eligibility of people with intellectual
disabilities for participation in international paralympic sporting events. This Committee
was seeking a rigorous objective set of criteria where cut-off points were absolute. It
was argued by the International Paralympic Committee that, as such tests existed for
the assessment of physical impairment (a position that is questionable), there should be
similar robustness in assessing the eligibility of competitors purporting to have an intellectual disability. Extensive debate ensued as to whether the cut-off point was an IQ
score of 70 or 75. A key barrier in the minds of the International Paralympic Committee was that so many of the athletes with intellectual disabilities looked normal, so
the reasoning was they did not have a disability.
Another experience concerned the role of the measurement of adaptive behaviour in
the assessment of eligibility for support. The inquiry concerned a person whose IQ score
fell within the accepted denition but whose adaptive behaviour score was in the average
range. This person was being denied support on the grounds he did not meet the necessary
criteria, because of what was seen as a false positive. There is a similar predicament when
the reverse is the case, leading to a false negative. This is the situation for many people
whose IQ falls in the borderline range. In terms of the support needs model, their needs
may be of greater intensity and duration than someone with a lower IQ, but they are
denied services because they do not meet the necessary diagnostic criteria.
Conceptual Models of Intelligence
These examples highlight the weaknesses inherent in the assessment of intellectual
functioning with existing instruments. However, the essential problem does not fully lie
with the tests; the shortcomings of which are adequately canvassed in this edition. The
challenge goes much deeper into the question of what we mean by intelligence or intelligent behaviour. Each new edition of the Manual has attempted to address this core

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issue, and I agree with Greenspan (2006, p. 167) that the current AAIDD denition is not
there yet. One of the reasons for this, I believe, has been the inuence that the positivist
applied behaviour analysis approach has had upon the study of intellectual disability;
replacing to a great extent earlier cognitive-based traditions (cf. Brown & Campione,
1981; Campione & Brown, 1987; Inhelder, 1966; Spitz, 1988; Zigler & Seitz, 1982).
Another force impacting upon the development of a coherent theory of intellectual
functioning has been the growth of the social model of disability and the subsequent
shift away from the role played by impairment. Whilst the 2002 and the current Manual
claim to align closely with the principles of the ICF (WHO, 2001), one may question
whether the pendulum has swung too far in the role the environment plays in the equation. In fact the philosophical underpinning of the ICF encourages a merging of the
social and medical models of disability.

Is Intellectual Disability Characterised by Decits in Learning or Decits in

Thinking?
Greenspan (2006) has drawn a distinction between decits in learning and decits in
thinking, inuenced by the earlier work of Spitz (1988). In this context the recent Manuals appear to place more emphasis upon the former, also exemplied by the thrust of
the UK nomenclature of learning disabilities. Behavioural learning theory (e.g., Gold,
1973) certainly provided a welcome boost to the eld when it was able to show that
people with quite severe intellectual disabilities were able to learn complex skills. But
we have to a large extent ignored the need to address more closely the issue of thinking; hence we are still grappling with the issue of generalisation of learned behaviours
into new and sometimes quite challenging situations. It is in these very practical everyday life situations, such as employment and community living, where we need a clear
theoretical basis to inform not only the supports a person with intellectual disabilities
requires, but also to inform us how to design methods to improve their strategic thinking. Greenspan summed up this position:
The term intelligence implies thinking while skill implies learning. The essence of MR
[mental retardation], from the standpoint of denition and diagnosis, is thus found not in
the relative absence of routine skills but in the relative inability, especially under conditions
of ambiguity or stress, to gure out when and how to apply those skills. (2006, p. 176)

Is Intelligence a Single Trait, a Multitrait Hierarchical Phenomenon or are there

Multiple Intelligences?
The current Manual states: although reasoning, adaptation, comprehension, and thinking are somewhat descriptive of intelligence, the construct itself has successfully eluded
a denition that is acceptable to everyone (Schalock et al., 2010, p. 32). There follows
a relatively brief analysis of the major contemporary conceptual frameworks, with the
conclusion that the multifactorial or multiple intelligences theories of intellectual functioning do not possess robust measurement instruments that are psychometrically sound.
Therefore, the practice of reliance on a global (general factor) IQ as a measure of intellectual functioning (Schalock et al., 2010, p. 41) will be maintained. This reasoning is
almost an admission that if we cannot measure something, it does not exist.
As both the single trait and the multitrait hierarchical approaches ultimately yield a
single factor, referred to as the g factor, following Spearmans factorial work

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(Spearman, 1927), the assumption then is that standardised IQ tests provide a valid and
reliable measure of this general factor. Whilst the T&C Committee are at pains to demonstrate the scientic integrity of their proposals, they acknowledge several challenging
issues related to the measurement of intelligence and the interpretation of IQ scores.
These include measurement error and the determination of the cut-off score, the Flynn
effect (Flynn, 2007), and the problems associated with extreme scores (Salvador-Carulla
& Bertelli, 2008). Despite these and other shortcomings of IQ testing for this population, and despite the Committees caveat concerning over-reliance on the IQ score in
the diagnostic process, one is still left with the impression of the primacy of the IQ
criterion in the process. There is a need to critically examine, as suggested by Schalock
(in press), the interface between the functionalistobjectivist paradigm of intellectual
disability adopted by AAIDD and the interpretivesubjective paradigm espoused by
writers such as Greenspan and Switzky (2006) to determine whether there are grounds
to reconcile these two approaches.
Adaptive Behaviour or Adaptive Intelligence?
The current Manual and its two predecessors have emphasised the role of the second
prong of the denitionadaptive behaviour. Despite adaptive behaviour being integral
to the denition since the publication of the 1959 and 1961 versions, in practice it has
largely been ignored. In order to strengthen the case for adaptive behaviour measurement as a second, equally important, but separate criterion in the denition, the 2002
Manual was inuenced by Greenspans tripartite model of adaptive intelligence to
underpin a strengthened adaptive behaviour construct. Using Thorndikes (1920) model
of multiple intelligences, Greenspan (1979, 1999) proposed that intellectual disability is
characterised by decit in three types of intelligence: conceptual (or academic, and measured by IQ tests), social (understanding of people and social processes), and practical
(understanding of mechanical objects and processes). The latter two non-academic
domains, Greenspan, Switzky, and Graneld (1996, p. 127) suggested, comprise everyday intelligence, which is applied in real-world settings and problems. This position is
supported by Sternberg (1984), in one of his few references to intellectual disability.
Greenspan (2006) argued that the T&C Committee have misconstrued his model in the
support of the adaptive behaviour construct, pointing out that adaptive behaviours (the
latter two domains of his model) are in fact an integral part of adaptive intelligence.
This position has gained support from Simeonsson, Granlund, and Bjorck-Akesson
who, in commenting on the 2002 Manual, suggested that:
In the AAMR [American Association on Mental Retardation] 2002 system, adaptive behavior is presented as a distinct element of mental retardation, separate from intelligence.
Adaptive behavior, however, is not a separate and independent component of MR, but an
expression of underlying cognitive ability. This is supported by the fact that the correlation
between measures of intelligence and adaptive behavior is generally high. (2006, p. 253)

Schalock (1999, 2004, 2006), on the other hand, whilst acknowledging the strength
of the arguments, is a little more conservative, suggesting that the merging of the constructs of intelligence and adaptive behaviour into an overall framework of person competence is still some way off. It is interesting to note that Gunzberg (1968), many years
ago when cognitive aspects of the construct of intellectual disability were more clearly
emphasised, saw social competence as a key element of the construct. This was
reected in the special education curriculum for students with intellectual disabilities

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that I and others used in the early 1970s. We perceived that social competence would
be a key factor for these students making a successful transition into adult living,
including successful employment. In this context research has demonstrated the critical
importance of social competence for successful employment outcomes (Greenspan &
Shoultz, 1981; Riches, 1993, 1996a, 1996b; Riches & Green, 2003).
One of the problems of current instruments designed to measure adaptive behaviour
is their reliance on skills of activities for daily living, possibly inuenced by the impact
of learning theory (e.g., Horner, Meyer, & Fredericks, 1986) and the strong emphasis
upon independent living in the deinstitutionalisation era. There is an important distinction between having the skill to be able to brush ones teeth and knowing why it is
important for the maintenance of oral hygiene.
The Manual also recognises that there are psychometric difculties in making a normative evaluation of adaptive behaviour, and suggests that alternative assessment strategies may need to be developed in order to dene what are signicant limitations in
adaptive behaviour. If, as some have suggested, adaptive behaviours are an integral part of
intellectual functioning, we may need to start afresh and design a completely new set of
instruments that are more reective of the underlying construct we currently call intelligence.
Systems of Support
Part III of the current Manual on Systems of Supports continues the paradigm shift heralded in the 1992 Manual, which emphasised that intellectual disability is a state of functioning instead of an inherent trait (Luckasson et al., 1992, p. 105). Of particular value in
this Part is the proposition that prevention at primary, secondary and tertiary levels of education can be seen as a form of support. This chapter leads into another useful discussion
regarding supports in the areas of physical and mental health, both of which are signicant
risk areas for people with intellectual disabilities. The chapter on support needs for persons
with intellectual disability who have higher IQ scores is a welcome addition. It is rightly
pointed out that this population makes up from 80 to 90% of all people diagnosed with
intellectual disability, yet they are generally the last to receive support when it comes to
the allocation of resources. This is the population that is extremely vulnerable in the areas
of community living and working, characterised by Edgerton (1967) as having a Cloak
of Competence. It is here where the characteristics described as gullibility (Greenspan,
2006, p. 183) and risk-unawareness (Greenspan & Switzky, in press) are particularly
pertinent. It has been well established that this population is over-represented in the criminal justice system owing to their tendency to make unwise choices (Lindsay et al., 2010;
Riches, Parmenter, Wiese, & Stancliffe, 2006).
Implications for the Field
The nal section of the Manual, Part IV, discusses the implications of the denition and
classication system for public policy, education, and for support provider
organisations.
In the chapter on the implications for public policy, the synergy between the changes
in assessment and classication systems and developments such as individualised
supports, individualised funding, person-centred planning and home-based supports is
highlighted. Also emphasised are core concepts at a person-referenced level, such as
self-determination, inclusion and empowerment; and those that are system-referenced

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such as the United Nations Convention on the Rights of Persons with Disabilities (United
Nations, 2006).
As noted above, the T&C Committee engaged in a number of activities leading
up to the nal publication of the Manual. These included a series of published
papers on issues around the denition and classication of intellectual disability. It is
interesting to note a continuation of this practice in the follow-up paper on public
policy and outcomes by Shogren and Turnbull (2010). They argued that the public
policy framework outlined in the current Manual makes a signicant contribution by
demonstrating the connections among inputs, policy and practice, and outcomes, not
only for individuals but also for families, society and systems. This framework is
not dissimilar to the systems model of evaluation developed by Parmenter and Fraser
(1980).
Conclusion
Since the publication of its rst Manual in 1921, the AAIDD has provided leadership
in the quest to understand, dene and classify the construct of intellectual disability.
As the denition and classication systems have evolved in subsequent years it is
recognised that several factors have impinged upon, and to a certain extent restricted,
the task of the committees charged with the responsibility of presenting the most contemporary and robust portrayal of what is meant by intellectual disability, its measurement and classication. We have witnessed the force of advocacy groups that has led
to changes in nomenclature. Governments, researchers, professional bodies, families
and support agencies look to a denition and a classication system that is precise,
valid and reliable. There is also an extremely broad range of approaches to the study
of cognition in the generic research eld, paralleled by differing epistemological and
ontological approaches within the disability research community. In the evolutionary
journey to nd a denitive answer to the questions of what is intellectual functioning
and what is intellectual disability, much more collaborative and interdisciplinary work
remains.
As we move ahead on this journey into the twenty-rst century, a number of factors
should guide our ongoing quest to seek answers to these questions. First, we must
move out of our psychometric laboratories and more sensitively observe the way this
population lives their practical everyday lives. People with intellectual disabilities themselves are demonstrating their capacity to learn and become contributing citizens
beyond the constricted expectations formerly held concerning their capacity as human
beings. This is not to ignore, however, the contributions of neuro-psychological
researchers, but in recent years we have not seen that group as integral partners in the
quest. Therefore, it is refreshing to acknowledge the publication of two special issues of
the Journal of Intellectual Disability Research, edited by Henry, Cornoldi, and Mahler
(2010), on the topic of working memory and executive functioning in individuals with
intellectual disabilities. Second, as the globe is shrinking, given the communication age,
we must be more sensitive to differing cultural approaches to the construct of intelligence, the richness of which has the potential to inuence our traditional western thinking (cf. Sternberg, 2004). Third, I agree with Schalocks (in press) prediction that
ongoing deliberations need to address several emerging epistemological issues; in particular the construct of disability and how intellectual disability ts within the general
construct of disability.

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