Redefining Mental Retardation
May Significantly Effect Services

By Herbert M. Weis, PhD

Clinical Psychologist

VP, Technical Services, Horizon Health Services

from Spring 1994

The May 1993 edition of the American Psychological Association Monitor included an article entitled "Tug-of-War is Developing Over Defining Retardation." This article described the current debate regarding the possible redefinition of the criteria for the diagnosis of "mild mental retardation." The debate is focused around the use of I.Q. (intelligence quotient) test scores in defining mental retardation.

Proponents for change argue for a more flexible use of the I.Q. scores, and a greater emphasis on individuals' functional abilities. This would mean that some persons now diagnosed as having "borderline intellectual functioning" could be diagnosed as having "mild mental retardation." The supporters of the current system claim that there is no scientific basis for increasing the present I.Q. score cutoffs, and that expanding the definition to include some persons in the "borderline" group would unfairly stigmatize those individuals. There would also be financial and regulatory consequences, as many additional persons would be defined as newly eligible for services.

As a psychologist working for Horizon Health Services, an agency serving persons diagnosed with psychiatric disabilities, mental retardation, and borderline intellectual functioning, I can appreciate the concerns raised on both sides of the issue. However, I believe that our central concern should be our responsiveness to individuals in need. As I wrote in my letter to the MONITOR editor, the outcome of this debate is of much greater significance than that of scientific definition. The outcome will determine whether we provide needed services to the millions of individuals who score just above the I.Q. cut off, but find themselves increasingly unable to function in our ever more complex society.

We need to deal with the current realities. While there is certainly a shortage of services for persons with retardation, the range of services available to these individuals vastly outstrips those available to clients who manage to score just beyond the I.Q. cut off. Although services for persons with mental retardation may have waiting lists, at least they exist. We also need to recognize that, although I.Q. scores are supposed to be used flexibly (the official cut off for mild mental retardation is an I.Q. a score of "approximately" 70), agencies serving persons with mental retardation routinely apply this number quite rigidly. It's not their fault. They are forced by their budgets to limit the number of persons they serve.

So what happens to the individuals who score barely "over the line?" Unfortunately, they often end up (by default) in the mental health treatment system where few, if any, specialized services are available to meet their needs. Many receive "soft" mental health diagnoses simply to justify their eligibility for even these few services.

But what of the stigma associated with receiving a mental retardation diagnosis? In contrast to the expressed concern, I am often faced with the pleas of clients, counselors, and family members that I interpret test results as conservatively as possible so that the client might be diagnosed with retardation. The receipt of the diagnosis provides access to variety of much needed day treatment, case management, sheltered employment and residential options. Concerns regarding a stigma are often less important than those regarding survival and quality of life.

The outcome of this debate is as yet unclear. It is only a part of the current process to revise the entire psychiatric diagnostic system. Ironically, in the prior diagnostic system (DSM-II), mental retardation was defined as extending through an I.Q. of 83. In converting to the present system, the diagnosis "borderline mental retardation" was recast as "borderline intellectual functioning," thereby excluding millions from needed services. The labels changed, but the people didn't. It makes one wonder to what extent funding, rather than research, influences the criteria for diagnosis.