DDS eligibility decision summary – Hudgins 2010-29
Keyword: manifestation before age 18
Hearing Officer: Marcia Hudgins
Counsel present for Appellant: Yes (Both names redacted)
Counsel present for DDS: Yes, C.J. Gange, Esq.
Appellant present: No
Hearing Officer decision: 2010
Commissioner letter: 2010
Diagnosis regarding MR in report (or info on disability affecting result of testing)
Results consistent with severe learning disabilities. Cognitive functioning ranges from average to mentally deficient. Verbal comprehension: 94; Working memory: 69; Processing Speed: 63.
Scored in the lower end of the borderline range and is ranked in the 3rd percentile. Verbal comprehension index score 94; Perceptual Organization Index score 74. Vast discrepancy in scores indicates severe learning disability and neurological deficits.
Verbal comprehension index score 91; Perceptual Organization Index score 69; Working Memory Index score 67; Processing Speed Index score 68. Doctor conducting evaluation stated that Appellant is performing overall in the mild mental retardation range based on the DSM-IV-R regulations.
Verbal Comprehension Index Score: 72; Perceptual Reasoning Index Score: 69; Processing Speed Index Score: 62. Dr. Crenshaw noted in his report that Appellant needs prompts in all aspects of daily living and needs structure around food or he will eat until he becomes sick. Severe anxiety. Appellant’s intellectual power depressed and formally within the range of mild mental retardation.
Diagnosis regarding MR in report, if any (or info on disability affecting result of testing)
Doctor concluded the Appellant fully met criteria for diagnosis of Mental Retardation according to standards including the AAMR, based on his sub-average intellectual functioning and his limitations in at least for adaptive skill areas.
The issue in this case is whether the Appellant is a person with sub-average intellectual functioning as defined by the American Association on Mental Retardation, so as to meet eligibility for DDS supports set out in 115 CMR 6.03 and 115 CMR 2.01. DDS changed its definition of “mental retardation” and incorporated the definition of “significantly sub-average intellectual functioning” effective June 2, 2006. Because the Appellant’s application for DDS supports was filed before June 2, 2006, the earlier definition employing the standards of the AAMR applies to this matter.
The American Association on Mental Retardation standards establishes a three-prong test for mental retardation. The only prong of the test at issue here is the first prong relative to IQ. The AAMR standard requires that the individual “must have significantly sub-average intellectual function defined as an IQ score of approx. 70-75 or below, based on assessments that include one or more individually administered general intelligence tests” to meet the standard for mental retardation.
Dr. Costigan, DDS Psychologist, concluded in 2008 that the Appellant did not meet the criteria for adult services because the Appellant’s evaluation in 1998 resulted in IQ scores significantly above the level warranting a diagnosis of Mental Retardation. In 2009, Dr. Costigan again came to the same conclusions even though he had not met the Appellant—he stated that he believed he had enough information available to him to perform the reevaluation of the Appellant without personally observing him. In contrast, Dr. Crenshaw noted after a 2009 evaluation that Appellant was formally within the range of mild mental retardation. At the 2010 hearing, however, Dr. Crenshaw stated that he did not believe the Appellant to be mentally retarded because the Appellant’s earlier Verbal Comprehension score of 94 would not be seen in someone with mental retardation. He explained that individuals with mental retardation are globally suppressed.
Arguments for eligibility of services on behalf of the Appellant included opinions of two examiners that found the Appellant to be mentally retarded based on FSIQ scores of 71 and 72. Hearing officer gave consideration of these opinions; however, found that the doctor improperly applied the AAMR definition of mental retardation because he did not include the requirement that the individual’s intellection impairments and deficits in adaptive functioning must have manifested before the age of 18. The hearing officer found the Appellant not to be a person with sub-average intellectual functioning as defined by AAMR, reasoning although Appellant was found to have significantly sub-average intellectual functioning on a number of occasions, none of the examiners were able to establish his level of functioning prior to age 18, which is a necessary component of the AAMR definition. HO determined the best evidence of Appellant’s diminished functioning at that time was the testing performed closest to age 18, when he received a FSIQ of 77. Further, HO dismissed a prior diagnosis of mental retardation as irrelevant in this case because the doctor based her diagnosis on the DSM-IV-R regulations, not the AAMR standards as required by DDS regulations.