The Specifiers, Intellectual Disability (Intellectual Developemental Disorder)

According to the DSM-5 there are four specifiers for this disorder; mild, moderate, severe and profound. While assessing for the level of severity for this disorder the therapist must look at three specific realms of the individual’s life to make the proper distinction. The table lists those three realms as the conceptual domain, social domain and practical domain.

Mild

• Conceptual Domain

  • Pre-school children

    • No obvious conceptual differences among age-mates

  • School-age children and adults

    • Difficulties in academic skills that could be addressed with support however there is a structure in the way they approach issues

• Social Domain

  • In this domain, as compared to age-mates, the individual may appear more immature than peers. There is difficulty in understanding social cues among peers, difficulty regulating emotion and a limited understanding of risk which raises the possibility of gullibility.

• Practical Domain

  • Personal Care

    • May function appropriately amongst age-mates within this realm

  • Daily Living Tasks

    • Would need support for more complex daily living tasks (i.e. meal preparation, grocery shopping, transportation, home and child-care preparation, money management)

  • Recreation

    • Able to perform as well as age-mates

    • Difficulty related to judgement regarding well-being and organization

  • Employment

    • Competitive employment in jobs that don’t emphasize conceptual skills

  • Health and Legal

    • Support needed for health care decisions and legal decisions

    • May need support raising a family

Moderate

• Conceptual Domain

  • Pre-school children

    • Language and pre-academic skills develop slowly

  • School-age children

    • Progress in reading, writing, math, understanding of time and money occurs slowly and is limited compared to peers

  • Adults

    • Academic skill development is at an elementary level and support is needed for both work and personal life

    • Assistance is needed daily to complete daily conceptual tasks and someone may complete takeover the tasks for the individual

• Social Domain

  • Generally able to communicate however less complex than peers. Individuals are able to maintain friendships and romantic relationships however have difficulty interpreting social cues. May need caretaker assistance in making life decisions. Relationships may be affected due to limited communication and social skills.

• Practical Domain

  • Personal Care

    • Generally able to care for personally needs however needs extending teaching to become independent in this area

  • Daily Living Tasks

    • General household tasks are able to be completed throughout adulthood however support may be needed to ensure adult level performance in this area

  • Recreation

    • These skills can be developed over time

  • Employment

    • Able to gain independent employment however in a limited capacity depending on the level of conceptual and communication skills involved. May need support from peers and management at work for ongoing success.

Severe

• Conceptual Domain

  • Ability to gain conceptual skills are limited. There is little understanding of written language or concepts involving numbers such as quantity, time and money. Caretaker support needed for problem solving.

• Social Domain

  • Spoken language is limited. May only speak in single words or phrases or only communicate through suggested means. Speech may be limited to only general communication instead of expressing more complex thoughts. In terms of understanding, simple speech and gestures are understood. Relationships with family and familiar members (such as family friends) may provide assistance and general pleasure.

• Practical Domain

  • Generally needs support in all activities of daily-living. Also needs supervision at all times due to inability of making responsible decisions for self and others. May be able to gain skills however needs long-term teaching and ongoing support to do so.

Profound

• Conceptual Domain

  • Skills mainly involve the physical world rather than symbolic. Object use is mainly goal-directed. Visuospatial skills (visual perception of special relationships of objects, i.e. matching and sorting) may be acquired but there is difficulty in functional use of objects outside of that.

• Social Domain

  • There is limited understanding in symbolic communication. Expression of desires and emotions mainly through nonverbal, nonsymbolic communication. With familiar people there is an enjoyment of the relationship (family, familiar people, caretakers).

• Practical Domain

  • Dependency on others for all aspects of daily living is apparent in this realm. May be able to help with daily work tasks in the home if there are no physical impairments. May be able to participate in recreational activity with support. Co-occurring physical and sensory impairments are behaviors to participation In various activities.

All information was gained directly from the DSM-5.

Phoro sourced from Pearl Buck