American Association on Mental Retardation Diagnostic Classification

Tammi Reynolds, BA & Mark Dombeck, Ph.D.

The American Association on Mental Retardation (AAMR), founded in 1876 by Edouard Seguin, is the oldest organization comprised of professionals from diverse disciplines concerned with mental retardation. Headquartered in Washington, DC, the AAMR has dedicated itself to researching mental retardation, promoting mental retardation policy, and developing interventions and treatments useful for helping mentally retarded people.

The AAMR has taken responsibility for defining mental retardation diagnostic criteria since 1921. Because the organization takes changes in clinical approaches and new discoveries through scientific research into consideration, their definition of mental retardation has changed ten times in the last one hundred years.

The DSM-IV definition of mental retardation tends to follow the AAMR definition. The DSM-IV is typically used by doctors to help make a diagnosis of mental retardation; however, the AAMR definition is helpful in creating an organized treatment approach for the individual who is diagnosed.

Presently, the AAMR currently defines mental retardation as "…a disability characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills."

The purpose of diagnosis, in the AAMR's view, is to help ensure the best available treatment can be provided to patients. Accordingly, the diagnosis of mental retardation should be made with an eye for organizing available treatments and interventions. The best way to do this is to consider a wide range of information while making a mental retardation diagnosis, including sensory, motor, and behavioral factors as well as social and intellectual data. Identified deficits should be defined in relationship to normal peer functioning and not with reference to absolute norms that may not apply well. Although weaknesses define mental retardation, it is also important to identify areas of relative strength, as these can be used to help organize treatments. Both strengths and weaknesses should be documented in an individualized support plan (ISP). Adequate and personalized supports and interventions should then be made available to the patient based on this support plan as resources allow, ensuring that patients get the best available care and support to help maximize their quality of life.

In addition to establishing whether the diagnosis of mental retardation is appropriate for a given case, the AAMR diagnosis process is also designed to classify the extent of mental retardation present. In providing for classification of mental retardation, the AAMR system looks to the individual's strengths rather than his weaknesses. It categorizes each individual's level of functioning based on the level of support that person will require in order to function:

• Intermittent support involves higher-functioning individuals who require little intervention in order to function, especially during times of uncertainty or stress. This group is associated with mild retardation.
• Limited support categorizes individuals who are trainable, but may require additional support to navigate through everyday situations. This group is associated with moderate mental retardation.
• Extensive support involves individuals who have some communication skills and can complete some self-help tasks, but who rely on daily support to function around the clock. This group is associated with severe mental retardation.
• Pervasive support describes daily interventions necessary to help the individual function. This lifelong support applies to nearly every aspect of the individual's routine. This classification is associated with those who have profound mental retardation.

The American Association on Mental Retardation's unique perspective looks at mental retardation as a classification within which lies a population that has many strengths as well as weaknesses. This is a relatively new way of looking at mental retardation. Historically, classification tended to focus solely on deficits, as the DSM-IV still does today.