DMR Eligibility Decision by H.O. Marcia Hudgins 11/18/06

Outcome: Eligible

Keyword: IQ testing after age 18; test validity; WAIS-R; marked early delays

Hearing Officer: Marcia Hudgins

Counsel present for Appellant: Frederick M. Misilo, Jr.

Counsel present for DMR: John C. Geenty, Jr.

Appellant present: No

Hearing Officer decision: 11/18/06

Commissioner letter: 11/30/06

Appellant is a 31 year-old female who resides with her parents in Massachusetts. When the appellant was 9 years old she was evaluated at Children’s Hospital in Boston. The tester noted that the appellant had marked delays in the areas of receptive language, language retrieval and expressive language. She also stated that visual memory and temporal sequential organization were areas of marked delay. The tester further noted that the appellant’s overall academic skills were considerably delayed and that significant receptive and expressive language problems were evident.

Additionally, two evaluations of the appellants intellectual functioning before the age of 18 were entered in evidence. When the appellant was 15 years old she completed the Wechsler Intelligence Scale for Children- Revised (WISC-R). On this test the appellant received a verbal IQ score of 74, a performance IQ score of 86 and a full scale IQ score of 78. There was no indication of who gave the test or his/her level of education, and no information relative to the test conditions or the validity of the test scores was given. When the appellant was 16 years old she completed the Wechsler Intelligence Scale for Children- Third Edition (WISC-III). On this test the appellant received a verbal IQ score of 63, a performance IQ score of 71 and a full scale IQ score of 64. The tester reported that the appellant had specific memory and word retrieval deficits that significantly interfered with her ability to perform intellectual tasks. They also stated that the appellant’s overall IQ scores did not adequately describe the range of her abilities or the specific learning deficits she displayed in the areas of word retrieval and memory.

Furthermore, three evaluations of the appellant’s intellectual functioning after the age of 18 were entered into evidence. When the appellant was 18 years old she completed the Wechsler Adult Intelligence Scale- Revised (WAIS-R). On this test the appellant received a verbal IQ score of 72, a performance IQ score of 76 and a full scale IQ score of 73. The tester reported that the appellant was functioning in the borderline range of intellectual functioning and that there was no statistically significant discrepancy between her verbal and performance scores. When the appellant was 20 years old she again completed the WAIS-R. On this test she received a verbal IQ score of 72, a performance IQ score of 80 and a full scale IQ score of 75. The tester gave a diagnosis of borderline intellectual functioning. Additionally, when the appellant was 29 years of age she completed the Wechsler Adult Intelligence Scale- Third Edition (WAIS-III). On this test the appellant received a verbal IQ score of 69, a performance IQ score of 77 and a full scale IQ score of 70. The tester noted that there was no evidence of depression, emotional disorders, anxiety, or impulsivity. He also stated that there was some evidence of left brain organic problems.

Thomas A Tashjian, Ph.D. testified as an expert on behalf on the appellant. Dr. Tashjian stated that the scores the appellant received on the WAIS-R that she took at age 20 were not valid since there was a new test (the WAIS-III) available at that time. He also stated that he supported the Children’s Hospital report and believed prior testing supported eligibility for DMR services. Dr. Tashjian further testified that the appellant’s functional deficits are due to her cognitive limitations, and that her cognitive deficits could be an explanation for all of her adaptive deficits. Moreover, Dr. Tashjian was confident that the appellant’s deficits have existed since 1985, pointing out the consistency in her strengths and weaknesses in prior testing. 

The DMR expert testified that evaluations that occur outside of the developmental period are not valid for determining the presence of mental retardation, and that the most reliable testing would be done prior to age 18. The expert further testified that he considered the WISC-III that the appellant completed when she was 15 years old to be valid, even though he could not explain why the appellant was given an 8 on the picture arrangement subtest when she did not take that portion of the test. The expert agreed that if the appellant were to have received the same score (3-6) that she had previously received on the picture arrangement subtest; she would have received a full scale IQ score of 75 or less.

The Hearing Officer found that the appellant met the DMR eligibility criteria because she had significant sub-average intellectual functioning, defined as an IQ score of approximately 70 to 75. The Hearing Officer did not give great weight to the WISC-III that the appellant completed when she was 15 years old for several reasons. There was no indication of who gave the test or their education/licensure, there was no report accompanying the test scores, and it was likely that the appellant’s full scale IQ score would have been lower than 78 had she taken the picture arrangement subtest and performed as she had on other administrations of the subtest.  Furthermore, the Hearing Officer did not consider the appellant’s IQ scores on the WISC-III she completed at age 18 because the test was administered too soon after the previous IQ test had been given, thereby rendering it invalid. The Hearing Officer gave great weight to the full scale IQ score of 73 that the appellant received just one month after her 18th birthday. She explained that because the test was given so close to the cut-off point for the developmental period she considered it the best evidence of the appellant’s intellectual performance during that period- given the problems with the previous two tests.

Moreover, the Hearing Officer considered the Children’s Hospital evaluation (completed when the appellant was 9 years old) in making her determination that the appellant had significant sub-average intellectual function prior to the age of 18. The evaluation pointed out that the appellant had marked delays in a number of areas and that her overall academic skills were considerably delayed. The Hearing Officer also found that the appellant has related limitations in at least 2 of 10 adaptive skills areas, and that these limitations were present prior to age 18 and continue to be present. She also noted that the appellant’s impaired intelligence seems to be the primary cause of such deficits, not psychological or emotional problems. The Hearing Officer further concluded that the appellant is in need of specialized supports in at least 3 of the 7 adaptive skill areas including community use, health and safety and work.