DDS Eligibility Decision by H.O. Silver, 2010-9

DDS Eligibility Decision by H.O. Elizabeth A. Silver, 2010-9

Outcome: Ineligible, Appeal Denied

Keyword: functional impairment,variability in IQ scores

Hearing Officer: Elizabeth A. Silver

Counsel present for Appellant:

Counsel present for DDS: Patricia Oney

Appellant present: Yes

Hearing Officer decision: 2010

Commissioner letter: 2010

 

Issue presented : Whether the Appellant meets the Department’s definition of mental retardation and is thus eligible for DDS services.

 

 

IQ

 

Year	Test	Age	Score			Diagnosis regarding MR in report (or info on disability affecting result of testing)
			Verb.	Perf.	Full
1998	WISC-III	9	65	80		ADHD
2001	WISC-III	12	63	82
2005	WISC-IV	16	57	65		“cognitive deficiency”
2008	WAIS-III	19	74	79	72
2009	WAIS-IV	20	70	81	70	“significant cognitive variability”

 

FUNCTIONAL ABILITY

 

Year	TESTS	Age	Score	Diagnosis regarding MR in report, if any (or info on disability affecting result of testing)
2008	ABAS-II	19	83	Patient in low average range
2008	Vineland -II	19		Communication – 66 (low) Daily Living Skills – 63 (low) Socialization – 71 (moderately low) Adaptive Behavior Composite – 64 (low)
2008	KTEA-II	19	73
2009	VABS-II	20	60

 

Appellant’s father testified that the Appellant’s birth was “difficult and he was born by emergency c-section.”  He was without oxygen for an extended period of time and his heart rate was very low.

 

The Appellant said he is currently in school at in and takes classes in banking, math, science and history. His foster mother had to cue him to answer the question.

 

Appellant’s clinician testified that the Appellant's diagnoses include ADHD, R/O Tourette's Disorder and R/O Expressive Language Disorder.  The clinician also testified that the Appellant's adaptive functioning is low. She works with him constantly on basic skills such as brushing his teeth, Showering, setting the table for dinner, saying please and thank you, and wearing appropriate clothes. She said the Appellant's short-term memory is limited and he needs to be cued constantly. She said he would bring in one grocery bag and then go to his room and forget about the other bags.  The clinician testified that the Appellant has limited social skills. The appellant will make inappropriate comments at times because he doesn't understand the social situation.

 

Dr. Bradley Crenshaw testified on behalf of the DDS and was qualified as an expert witness. He reviewed his Eligibility Report. The cognitive test scores show a consistent pattern of compromised verbal skills.  The other part of the Appellant's intellectual pattern was processing skills. His scores were in the low average-range.  Dr. Crenshaw explained that these results show “variable intellectual skills.” He said when there is a split between intellectual factors, averaging the scores “doesn't describe what's really going on intellectually but instead disguises particular areas of impairment as well as particular areas of strength.” Dr. Crenshaw also noted that because of this split in scores, from the Department's perspective the Full Scale scores don't pertain.

 

In 2000 the Appellant was diagnosed with ADHD. Dr. Crenshaw said the Appellant still has this diagnosis and it continues to influence his performance because of his distractibility. Dr. Crenshaw said the Appellant's scores fluctuate because he doesn't have secure cognitive control over his verbal skills, which is part of his disorder. In his nonverbal scores, the Appellant had low average skills, which was consistent with prior testing. Dr. Crenshaw also reviewed the behavioral assessments in the record. In conclusion, Dr. Crenshaw said he did not think the Appellant met DDS eligibility criteria because looking at the factor scores, “he has residual skills above the Department's threshold.”

 

The Hearing Officer (HO) was persuaded that the Appellant has significant limitations in his adaptive functioning.  He is not capable of managing money, he cannot do basic math, and he does not understand economic transactions. To attend to even the most basic personal living skills, such as brushing his teeth, the Appellant must be constantly cued. He needs to be prompted to care for his own hygiene. He is not able to generalize cueing from one day to the next.  He has significantly limited social skills. He has no friends with whom he spends any time, and he does not understand boundaries in relationships. The Appellant is not, and will not, be able to live independently. He will need significant supports throughout his life.

 

This finding does not mean that the Appellant meets the departmental definition.  Based on his performance scores, the variability between the verbal and performance scores, and the testimony of the Department's psychologist, the HO could not find that the Appellant had demonstrated that he had sub-average intellectual functioning.