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IMPLICATIONS FOR RESEARCH ON THE DEFINITION, CLASSIFICATION AND SUPPORT SYSTEMS FOR THE AAMR 1992. Promoting self-esteem

Robert L. Schalock, Ph.D. Hastings College

The concept and definition of mental retardation has undergone numerous changes over the past forty years, both in terminology and in the cutoff points based on the IC, as in the function of adaptive behavior as a diagnostic criterion. Each change reflects the continuous effort made by different disciplines to improve understanding of the condition of mental retardation and to develop a more precise terminology and classification practice and more focused on empowerment. In 1992, the American Association on Mental Retardation (AAMR), an organization that has defined mental retardation over the past 119 years, adopted a new definition and classification system based on a new conception of mental retardation. The purpose of this conference is to summarize this system (which we refer to hereafter as the "System 1992 ") and have four implications for research, arising from major changes in the conception of mental retardation is the System 1992. Before that, we first briefly summarize the changes resulting in the conception of mental retardation.

CHANGE IN THE CONCEPT OF MENTAL RETARDATION

Since 1983, when it was published the final manual classification of the AAMR (Grossman, 1983), there has been a significant paradigm shift in the field of delay mental. Here are three aspects of this change, namely: 1) mental retardation needs to be defined in a social context, 2) generally with appropriate supports for an extended period, the functioning of the person with mental retardation experience improvements, and 3) the practices of rehabilitation services are based on the capabilities, limitations and support needs of the individual.

mental retardation within a social context

An essential element in the change of conception is the idea that mental retardation is not an absolute trait expressed solely by the person, but an expression the functional impact of the interaction between the person with intellectual limitations in adaptive skills and environment of the person (Luckasson, et al., 1992). This view is reflected in Figure 1, which shows how a person's disability is the expression of functional limitations that occur in a social context, reflecting the interaction between intellectual limitations and adaptive skills, as well as the demands of their environment (Institute of Medicine, 1991).

Figure 1. The process of acquiring a disability

function supports

One of the four assumptions of the 1992 system is that generally, the functioning of the person with mental retardation will improve if you are offered the appropriate supports for a continuous period. This belief stems from the conceptual and practical interest to use the supports (natural) as a more efficient and effective means to improve services to enable individuals with mental retardation. Although the concept of support is not new, what we do is new is the belief that a judicious application of appropriate support can improve the functional capabilities of people with mental retardation. This belief is reflected in the current interest into programs such as supported employment, sheltered housing or support systems in the mainstream school. The importance of these supports is that they are a more natural, efficient and continued to increase independence / interdependence, productivity, community integration and satisfaction of these people.

As discussed later, the third step of the System 1992 focuses on the specific support required by the individual. Briefly, the third step involves determining the multidimensional needs of supports for persons with mental retardation and classify the intensity of this support as intermittent, limited, extensive or widespread.

Best practices for enabling

The paradigm shift described above has also had repercussions patterns of service delivery, placing the emphasis on the potential performance and capabilities of the individual, standard and typical environments in support of integrated services and the training of individuals. These trends have resulted in a significant redefinition of services, reflected in a person-centered planning and functional support model within the community (Schalock, in press).

In summary, there is a change in the conception of mental retardation worldwide that partly explains why the System 1992 has been translated into seven languages. Also, this change in philosophy, and the subsequent modification in approach focuses on three key elements of the conception of mental retardation: capabilities, and operating environments. These elements are reflected in Figure 2, where the operation occurs at the base of the triangle to note that the 1992 is basically a system functional model. The building, on the left side of the triangle, indicating that the operation in mental retardation is related specifically to limitations in intelligence and adaptive skills. The right side of the triangle represents the environment in which these individuals live, learn, work, socialize and interact. The model also shows how the presence or absence of support influences how it works in the community.

Figure 2. General structure of the definition of Mental Retardation

1992El System change in the conception of mental retardation summarizes the need to carry out three major changes in our beliefs. First, the categories referring to the person based solely on a single aspect (eg, severity of mental retardation) are not descriptive or predictive enough to characterize individuals with mental retardation. Second, the emphasis in the current operation requires more clearly describe the skills and adaptive limitations affect daily life, thus causing the need to identify key areas of specific adaptive skills to meet the challenges of each environment. And third, the diagnosis must be made with a view to planning the intervention and to certify a certain condition. These changes are reflected in the following summary of the Definition, Classification and Systems of Supports, 1992 (Luckasson, et al., 1992).

DEFINITION OF MENTAL RETARDATION

System In 1992, mental retardation is defined as:

"... substantial limitations in present functioning. It is characterized by an operating intellectual significantly below average, which coexists with associated limitations in two or more of the following adaptive skill areas: communication, self care, home living, social skills, community use, self-direction, health and safety, functional academic skills leisure activities, and work. The mental retardation must occur before 18 years of age "(Luckasson, et al, 19992, pg. 5).

THE THREE-STEP PROCESS

Any system for diagnosing a mental retardation person and classified according to criteria, consists of a set of formalized rules that specify requirements to be met to be diagnosed and classified as such. Over the years these rules have undergone changes in response to pressure from consumers, professionals and other social and political forces. The 1992 system involves a three step process that includes: the diagnosis of mental retardation, the description of the capabilities and limitations of the individual and the identification of the necessary support. These three steps are summarized in Table 1.

The three-step process: Diagnosis, Classification and Systems of Supports

Step 1: Diagnosis Mental Retardation (Determines whether a person should be selected as the recipient of support)

mental retardation was diagnosed if:

1. Individual's intellectual functioning is about 70-75 or lower.

2. There are significant limitations associated with two or more adaptive skill areas

3. The age of onset is 18 years or less.

Step 2: Classification and description (Identify the capabilities and limitations and the resources required)

1. Describe the capabilities and limitations of the individual related to the psychological / emotional

2. Describe the general physical condition and indicates the etiology of their condition.

3. Describe the typical environment of the individual and the optimal environment that is conducive to their growth and development.

Step3: profile and intensity of support required (Identify the support required)

Identify the type and intensity of support required in each of the four dimensions:

1. Dimension I: Intellectual functioning and adaptive skills.

2. Dimension II. Considerations Psychological / Emotional.

3. Dimension III. Physical Considerations / Health / etiology.

4. Dimension IV: Environmental Considerations.

The three-step approach described in the above table differs from the classification system of the AAMR in 1983 (Grossman, 1983) that:

• code uses a single diagnosis of mental retardation if the person meets the three criteria of age of onset, intellectual functioning significantly below average and associated limitations in two or more adaptive skill areas.


• uses a multidimensional approach to describe the capabilities and limitations of the individual.


• Develop a profile of the support needed for each of the four dimensions.

Diagnosis intervention plan

1992 System believes that the primary goal of diagnosis is to help plan the intervention. The use of diagnostic data in order to schedule the intervention should achieve better results in individuals with mental retardation, including the provision of essential services to increase independence, productivity, community integration and satisfaction. This move also means the process diagnosis beyond mere labeling of individuals (for example, "a person with severe mental retardation") into a description of the person and the support you need (for example, "a person with mental retardation with extensive support needs in the areas of communication and limited support needs in the area of \u200b\u200bcommunity use. ")

IMPLICATIONS FOR RESEARCH SYSTEM 1992

A recent article by the author (Schalock, et al., 1994) sets out various implications of the System 1992 in the field of mental retardation related to the basics of classification, confidence in the clinical trial, the provision of education and empowerment, the emphasis on prevention, and guidelines for research in the field of mental retardation. In this paper suggests that the System 1992 will have a major impact on research on mental retardation in the first place, by requiring greater precision to describe individuals with mental retardation and, secondly, to shift the emphasis initially put on the individual as an independent variable, to the environment and support as independent variables and to the adaptive skills of the person, the status of housing / employment, quality of life and satisfaction as dependent variables.

addition

overall impact of these two, in this section we will focus on four specific research implications derived from the System 1992. These are: 1) a broader definition of the concept of intelligence, 2) validation of the overall dimensions of adaptive behavior, 3) operationalizing a paradigm of support, and 4) analysis of the environments.

1. Extending the concept of intelligence

What is intelligence and what role it might play in the definition and diagnosis of mental retardation?. The assessment of intelligence is going through a time of confusion, changes looming on the horizon. For example, in 1982, a working group of the National Academy of Sciences recommended to reduce the weight given to standardized tests in the United States. Currently there is a clear decrease in reliance on the IQ test and see how many districts have gone from using IQ tests to use test of achievement and ability (Snyderman and Rothman, 1987). In addition, other authors (Reschly, 1981; Turnbull, 1979) have argued that the concept of CI is generally poorly understood, making it a myth that has endured more than its utility. So they propose relabel IQ test as a test of academic skills or aptitudes académicas.A with decreasing emphasis on the measurement of general mental ability, they begin to see people who defend not only the assessment of specific mental abilities, but also the development of a broader definition of the concept of intelligence. Interestingly, in 1920 Thorndike described a tripartite model of intelligence that included social, practical and conceptual intelligence. A recent study (Greenspan, 1979, 1981, Greenspan and Granfield Switzsky, 1994, Sternberg, 1988, 1994) defines these three concepts as follows:

• Social intelligence includes the ability to respond appropriately to human relations (Taylor and Cader, 1989) and the existence of appropriate interpersonal skills (Bennett, 1993, Cantor and Kihltrom, 1987, Sternberg and Wagner, 1986).


• Practical intelligence includes daily living skills, and ability to adapt successfully to different environments and to show enough skill in self environment (Sternberg, 1984).


• Academic intelligence includes the traditional notion of IQ and school skills (Greenspan et al., 1994).

From a research perspective, we here at least six implications for this (possible) design broader intelligence including:

• Integrate a tripartite model of intelligence also adopting an approach to primary mental abilities to design intelligence. For example, Thurstone (1938) suggested that multiple intelligence includes skills such as verbal fluency, verbal comprehension, spatial ability, perceptual speed, numerical ability, inductive reasoning and memory. More recently, Gardner and Hatch (1989) have suggested "seven intelligences", namely: the logical-mathematical, linguistic, musical, spatial, bodily-kinesthetic, interpersonal and intrapersonal.


• Develop measures psychometrically powerful social and practical intelligence.


• determine whether social and practical intelligence are conceptually and pragmatically different (McGrew and Bruininks, 1990, McGrew et al., 1994).


• determine the role they can play the practical and social intelligence in the definition of mental retardation .- Verify the role of observation, self-report and clinical trial evaluating the social and practical intelligence.


• Differentiate practical and social intelligence as distinct components of adaptive behavior. Anastasi (1986) for example, states that "the behavior Smart is essentially adaptive, insofar as it represents ways of responding to the demands of a changing environment "(pp. 19-20).

2. Validation of the general dimensions that make up the adaptive behavior.

The concept of adaptive skills present in the System 1992 is a continuation of historical attention given to social competence in the diagnosis of mental retardation. A necessary criterion in the definition of mental retardation in 1992 is that there is an intellectual functioning significantly below average with limitations in two or more areas of adaptive skills as follows: communication, self care, home living, social skills, community use, self-direction, health and safety, functional academic skills, leisure, and work. The main objectives of the assessment of adaptive behavior are (Bruininks, McGrew and Maruyama, 18988, Horn and Fuchs, 1987, McGrew and Bruininks, 1989; Rechsly, 1990):

• diagnosis and intervention planning.


• evaluation and program monitoring.


• The description and investigation of the population.

The emphasis placed on adaptive skills (rather than adaptive behavior as in the definition of 1983) is a system change in 1992 due, in part, the debate emerged about the conceptual nature of adaptive behavior and subsequent problems related to measurement. The concept of adaptive skills involves different skills, thus providing a firmer basis for several key aspects of the system 1992, such as:

• often with limitations in adaptive skills, capabilities exist in other areas of adaptive skills or competence personal.


• The existence of capabilities and skills limitations adaptive to be expressed within the community settings typical age peers the individual and should be linked to the support required by the person, considered individually .- If the person has no limitations in adaptive skills, then applies the delayed diagnosis mental.


• The concept and measurement of behavioral skills "maladaptive" as synonyms for specific acts present in excess, highly undesirable or inappropriate, must be questioned because such behavior may be the answer to an unsuitable environment for a people who can lack of alternative communication skills. For this reason, the concept of maladaptive behavior is not included in the dimension I of the classification scheme, going to join the Dimension II (psychological and emotional considerations.)


• is necessary to emphasize the evolutionary significance of certain skills within the ten adaptive skill areas. Thus, attention must be paid to certain areas only when relevant to age, since several of them (eg, work) make sense only in adolescence and adulthood.

The main research approach used to date to identify the dimensions of adaptive behavior has been factor analysis. The results of this analysis using adaptive behavior indices supported the presence of multiple domains or areas that compose it. Although the results are contradictory to date (see McGrew and Bruininks, 1989 and Widaman, Borthwick-Duffy & Little, 1991 to excellent reviews on the subject), there is a reasonable agreement in the domains or overall dimensions of adaptive behavior. These are summarized below in Table 2. With respect to the domain of human abilities, a multifactorial approach seems more appropriate to describe the adaptive skills, which include hierarchical structure factors larger or more general higher levels of hierarchy, and specific factors in the lower (Widman et al, 1991). And although not shown in Table 2, there is also coincidence (Bruininks, Thurlow, and Gilman, 1987; Meyers, Nihira, and Zetlin, 1979; Widaman et al., 1991) speak of two types of maladaptive behavior: social maladjustment (which gives lead to aggressive behavior, destructive or antisocial threatening to damage or injury to others or property of others) and personal maladjustment (self-aggressive behavior and autistic behavior.)

is a clear need for further research on the structure of adaptive behavior. Recent reviews suggest research in areas following:

• vs Solving univariate positions. multivariate factor structure of adaptive behavior (Widaman, et al., 1991).


• include a larger number of samples, instruments and constructs (McGrew and Bruininks, 1989).

Explore
• adaptive behavior in the context of other constructs such as personal competence (McGrew and Bruininks, 1989).


• study contextual and cross-cultural bases of adaptive behavior as it has done the Adaptive Behavior Committee created specifically for this purpose by the AAMR.


• analyze other approaches to understanding adaptive behavior. For example, Reiss (1994) has recently suggested that factor analysis may be insufficient to identify all the behavioral components of adaptive behavior. A possible alternative would be to develop a model referred to a criterion (rather than referring to the standard) to assess adaptive skills at different ages, genders and cultural dimensions.


• Identify key indicators of behavioral skills that reflect the construct of adaptive behavior that emphasize the acquisition of daily living skills and achieve personal independence and social adaptation.

Table 2. General adaptive behavior domains

Author (s): Meyers, Nihira, and Zetlin (1979) proposed

Domains:

• self-help skills



Physical Development Communication Skills
Cognitive function



• domestic and occupational activities


• Self-Direction and Responsibility Socialization

Authors: Kamphaus (1987). Domains

proposed:

• Physical / Motor


• Self Help / Independence


• Interpersonal /

Social Responsibility


• Cognitive / Communication

Authors: McGrew and Bruininks (1989) proposed

Domains:

personal independence


Personal Responsibility Social Responsibility


• Functional Academic Skills / Cognitive
  
• Professional / Community


• Physical / Evolutionary

Authors: Widaman, Borthwick-Duffy and Little (1991) proposed

Components:

Motor Development Skills
• Independent Living


• Competition

Cognitive Social Competence

Authors: Widaman, Stacy and Brotwiuck-Duffy (1993) proposed

Components:

Cognitive Competence
• Competition Social


• Social Maladjustment


• Personal Maladjustment

3. Operational definition of a paradigm of support

disability field has recently experienced a renewed interest in the concept of support to enhance the independence, productivity, community integration and support provided to persons with disabilities ( O'Reilly, 1988; Schalock, 1994; Schalock & Genung, 1993; Starker, 1986). The evaluation of the profile and the intensity of support required by an individual is an integral part of the System 1992. The supports the proposed model is described in Figure 3. The four model components are: support resources (individual, other people, technology, and services), support functions (including education, security, economic planning, behavioral support, home help, access and use of community and school, and medical care), the intensities of supports needed and desired results.

Figure 3. Model Support Outcomes.

The intensity of support and examples of each are summarized in Table 3.

Table 3. Definition and examples of strengths support. Intermittent

Support "when necessary." Are characterized by their episodic nature. That is, the person does not always need the support (s). Consist of resources required for a short space of time, life-cycle transitions (eg loss of employment or the appearance of a medical crisis). The support provided may be high or low intensity. Limited

are characterized by consistency over time. That is, there are intermittent, although its duration is limited. May require a smaller number of professionals and lower costs than more intense levels of support (eg training in the workplace for a limited period or support during the transition from school to adult life.) Extensive

involvement or intervention assume a regular (eg daily) in at least some environments (eg work or home) and have no time limitations (eg long-term support in place work and home support long-term). Generalized

are characterized by consistency and high intensity. Are provided in different environments and can last a lifetime. Generally involve a greater number of professionals and a more extensive intrusion supports or limited time.

There are several implications for research arising from the inclusion of support in the System 1992. Namely:

• Need to operationalize the four intensities of support (based on criteria such as hours, for example).
• Need to develop standards or support.
• determine the criteria for withdrawing support when appropriate or, where appropriate, to reintroduce it. Establishment
• individualized supports, depending on the increase or decrease the required intensities.
• Assessing the role
  that meet these supports in the results obtained by the person, considered individually.
• financial systems development and pay based on the support needs of individuals with mental retardation.
• support
  assess whether met or not, in fact, improve and enhance the integration effectively.
• overcome some of the methodological problems in research on social support and social networks such as the absence of clear definitions and reliable assessment tools, lack of attention to the impact of negative and conflicting aspects of supportive relationships, and lack of attention to the effects of life events, individual differences in needs and environmental factors on social support (Starker, 1986).

4. Analysis environments

Recent studies have shown that a proper adjustment of people with disabilities is related to their environments, both with specific behavioral skills of the person as to the performance requirements specific to that context. (Schalock, 1986, 1989). These results are consistent with a social ecological model proposes that a good fit depends on both the programming measurement and contextual factors surrounding a person, and the facilitation of congruence between people and their environment (Romer and Heller, 1983). In addition, the current emphasis on the social validation emphasizes that an effective adjustment to the environment depends not so much on the individual characteristics per se, as the fit between the individual and environmental characteristics (Schalock, in press).

The second step involves describing the 1992 system in conjunction with Dimension IV ("Environmental Considerations"), both the normal environment in which it develops the individual as the best environment that would facilitate its continued growth and development. Therefore, the second step requires the user become familiar with the techniques of environmental analysis.

Currently there are different ways to analyze the environment, and continued efforts in this regard is one of the implications derived from the System 1992, more important for research. A brief description of two possible methods for this analysis:

1. goodness of fit. The author has spent several years evaluating the goodness of fit between people and their environments. Briefly, the procedure involves a three step process. The first step requires identifying the critical skills related to proper functioning or adaptation to an environment specific, such as housing or work. The second step necessary to determine, using a rating system of three levels, if the environment requires the skill and, if so, the level that is needed (independent, assisted, or not necessary). The third step involves assessing the performance level of the person in each skill according to the following three criteria: a) states that skill independently, without assistance, b) has that ability if you are offered some help (verbal or signs instigators memory), or, c) does not have this ability, either through lack of ability, interest or require physical assistance (Krejca and Schalock, 1985).

Once evaluated, data goodness of fit can be used for different purposes, either to provide an index of relevant skills that fit or not, to quantify the existing consistency in order to plan, monitor and evaluate the results, or analyze the discrepancy in order to establish empowerment strategies such as skills training, the use of prostheses and / or making environmental modifications.

A promising line of research in this area is reflected in two recent studies. Landesman (1987), for example, demonstrated the existence of an interaction between characteristics of individuals and their environments, and markedly different effects produced by similar environments in different people. For example, this author found that institutionalized individuals who had initially higher levels of social functioning and verbal prior to their relocation did not show significant behavioral changes in other contexts, while residents initially more passive and dependent pareceron benefit from its location in smaller homes. In a parallel research line, Schalock and Jensen (1986) reported that people with an appropriate adjustment to their environment (defined by an index of goodness of fit high) obtained better results in terms acquisition of skills, wages and evaluating their quality of life.

2. inhibitors and facilitators. The system 1992 reflects the importance currently given to environmental factors as elements that can facilitate or inhibit the growth, welfare and personal satisfaction. The authors of the 1992 system encourages users to identify those environmental factors that may have a significant impact on both the person and the results of its program to (re) habilitation. To facilitate the understanding and analysis environments, the user must consider the five following environmental factors: Inclusion

• comprising presence in the community (contexts and places) and participation in it (activities and level of involvement). Election
• including opportunities for autonomy, decision making and control.
• Competition includes opportunities to learn and develop functional and meaningful activities.
• Respect, reflecting the fact occupy a valid place in the home and community, and solicit their views on life experiences and their personal satisfaction.
• Support, providing support and assistance to promote independence, productivity and integration in the community (see Table 2 and Figure 2).

There are several implications of the research resulting from the emphasis placed in the System 1992, the environment. The most important are: 1) what aspects of each be analyzed, 2) what dimensions / criteria be used in this analysis, and 3) how to use the results obtained from the analysis. One of the major research challenges, caused by attempts to analyze the environment, is to develop multidimensional performance models that include indicators related to the level of adaptive behavior, status, role and personal satisfaction (McGrew, Johnson and Bruininks, 1994; Schalock, in press).

In conclusion, the System 1992, reflecting the change in the conception of mental retardation, has generated long debates on what constitutes mental retardation, on how to improve diagnosis, and on the criteria on which (if possible ) could be classified mentally retarded individuals.

exposed

As Kuhn (1970), reactions to the System 1992 does not differ from the reactions occurring at a scientific revolution, in which there are doubts and difficulties to a particular approach, approaches to conflict between "new" and " old "and the possible acceptance of a new paradigm characterized by having followers for being tested, and for being attractive and prometedor.La research will play a key role in the changes as they occur in the conception of mental retardation in its definition and consideration. We're not sure of what the following terminology and classification system. His character is undoubtedly influenced by the four areas of research just presented at this conference: expanding the definition of intelligence, validating the general domains that make up the adaptive behavior, operationalization of the paradigm of support and analysis environments. BIBLIOGRAPHY

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Fuente: http://www.usal.es/~inico/investigacion/jornadas/jornada1/confer/con1.html