Intellectual Disability

What is the DSM-V definition for intellectual disability?

A. Deficits in intellectual functioning (reasoning, problem solving, judgement

B. Deficits in adaptive functioning which limit functioning in one or more activities of daily life. (communication, independent living, social participation).

C. Onset of intellectual and adaptive deficits during developmental period (Childhood/adolescence).

What 3 key domains must it impair to be classed as an intellectual disability?

1. Conceptual domain - skills in reading, language, writing, math, reasoning, knowledge and memory.

2. Social domain - empathy, social judgement, interpersonal communication skills, ability to make and retain friendships.

3. Practical domain - self-management e.g. personal care, job responsibilities, money management, recreation and organising school/work tasks.

What is some alternate terminology for intellectual disability?

Mental retardation

Developmental disability

Learning disability

A. Intellectual functioning

One measure of the conceptual domain.

Required to test verbal comprehension, working memory, reasoning, abstract thought and cognitive efficacy.

Psychometric test of intelligence - IQ test

Mean IQ for general public is 100, IQ below 70 is considered impaired intelligence.

B. Adaptive functioning

Adaptive skills - how well someone meets community standards of personal independence and social responsibility compared to others.

Developmental

Modifiable

Adaptive functioning in 3 skill areas to define AF

• Conceptual skills - e.g. language

• Social skills - e.g. social problem solving

• Practical skills - e.g. daily living

Problems measuring AF in the CJS

Requires significant knowledge of the individual. (Smith, 2020)

Is it suitable for incarcerated individuals?

• Assessment measures refer to adaptive behaviours within community environments (Young et al., 2007).

• Includes items that are not relevant in prisons.

• Expensive and time consuming.

C. Onset before adulthood

Omits people for whom intellectual and adaptive impairments occurred due to trauma or illness.

Can be measured through reference to historical evidence including medical reports, educational records or notes from services accessed by the individual.

Assessment of intellectual disability in practice

Intellectual functioning was replied upon as sole criterion (BPS, 2001) but adaptive functioning has gained more recognition and can be seen in the DSM V.

WAIS assessment and adaptive functioning checklist.

5 boradly accepted categories:

• borderline - IQ - 70-80

• mild - IQ - 50-69

• moderate - IQ - 35-49

• severe - IQ - 20-34

• profound - IQ <20

Intellectual disability characteristics: Conceptual deficits

Language - limited vocabulary, confusion over word meaning, incorrect use of words, etc.

Memory - difficulty recalling memories, forgetful, difficulty retaining information, etc.

Processing - difficulty decoding sentences, slow responses, difficulty multitasking, etc.

Reasoning - difficulty using imagination, struggle with abstract concepts, difficult in new situations, etc.

Social and Practical deficits

Social - suggestibility, difficulty understanding body language, personal space, conversational rules, etc.

Practical - difficulty with skills like budgeting, finance, navigation and time, etc.

Additional characteristics associated with intellectual disabilities

• High prevalence of psychiatric disorder and mental illness.

• Poor planning and coping skills

• Poor decision making

• Poor impulse control

Intellectual disability and Crime - History

Late 1860s onwards - predisposed to criminality because of weaker mindedness

1880-1920s - threat to society - criminally inclined and dangerous (O’Callaghan and Murphy, 2007)

Subject to segregation and involuntary sterilisation.

1950s - community based services introduced

Late 1960s - 1970s - beginning of deinstitutionalisation

Link between IQ and offending

There is a significant relationship between IQ and offending.

High IQ has been shown to be a protective factor in offending (Ttofi et al., 2016).

Why? Could it be a direct relationship (unaware of the consequences of actions) or indirect (mediated by other factors)

Most studies employ IQ scores of 80-120 so this doesn’t mean there is a significant relationship between intellectual disability and offending.

Intellectual disability and offending - current thinking

ID no longer seen as a risk factor for offending.

certain characteristics may facilitate offending:

• Day (1993) - low socio-economic status, family history of criminality, history of abuse, history of behaviour disorder as a child.

• Holland (2004) - Vulnerabilities, poor coping, lack of independence.

• Day (1993) - History of victimisation or social exclusion may facilitate offending.

Prevalence of ID estimates

2.5% of UK public

15.2% charged in police stations

7.1% (IQ < 70) in prisons, however, very few individuals with moderate to severe ID in prisons.

Property offences, sexual offences and arson are over represented (Holland, 2004).

White collar crime and drug-related crime is under-represented (Lindsay, 2002)

ID and Arrests

1.3 million people are arrested in the UK a year.

When arrested, you have 3 basic rights (free and independent legal advice, inform someone where you are, to consult the police code of practice).

Police arnt trained to deal with ID:

• Police lack training and knowledge in dealing with individuals with ID.

• ID individuals confess more readily, provide more incriminating evidence, and are less successful in plea bargaining.

• More likely to be convicted and to receive longer sentences.

Appropriate Adult

PACE Code C - Vulnerable people must have an appropriate adult present.

Role - support, advise, assist

AAs are required by up to 15% of people who are arrested, only actually used for 4% of arrests.

Who can be an AA? - relatives, guardians, and experienced professionals.

Who can’t be an AA? - Police, under 18, anyone involved.

3 types of false confessions

• Voluntary false confessions

• Coerced-compliant false confessions

• Coerced-internalised false confessions.

False confessions and intellectual disability

ID seen as a risk factor to false confessions

PACE s.77 - if a confession is made by a mentally handicapped individual, the court will warn the jury that special caution is required before convicting.

R v McKenzie 1996 - A case should be withdrawn from the jury if:

• The prosecution case depends wholly upon confession;

• The defendant suffers from a significant degree of mental handicap;

• The confessions are unconvincing to a point where a jury could not properly convict them.

ID in Prison

Experiences difficulties adapting to prison rules and discipline.

More likely to be exploited by other inmates

Routinely excluded from activities

Increased risk of self harm and suicide

Risk assessment and ID

Relatively little specific provision for risk assessment specific to ID offenders.

Risk assessment is informed by evidence pertaining to the prevalence and nature of offending but we do not have a very clear picture of ID offending.

There is a lack of risk assessment measures which are specifically developed for use with ID offenders.

Treatment and ID

Traditional approaches to treatment of offenders are often not appropriate for ID offenders.

Lack of specialist treatment programme for those with ID in prison.