ID: History of a Sociocultural
Concept
Ibn Sina and Ibn Tufail

Canon of Medicine
–
Enlightenment,
Romanticism and DSM V
–
–

Hayy Ibn Yaqzan

Tabula Rasa
Development of the mind
Translated in 1671
–
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Paracelsus and Felix Platter
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Mental Illness
ID
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Fictional Feral Child
980-1037
John Locke
Swiss Physicians
Early Neurologists
Early Psych
Classification
Mental Alienation
–
Mind
Body
Vitality
First sub classes
Neonatal
Hypothyroidism
(Cretinism)
“We are born without innate
ideas, and that knowledge is
instead determined only by
experience derived from
sense perception”
a tabula rasa, which is
shaped by experience;
sensations and reflections
being the two sources of all
our ideas.
1536-1614
1493-1541
1632 - 1704
Jacob Rodriguez Pereira
First to teach a person
who was deaf and
non-verbal to sign
Valentin Haüy
Raised Type
1784 First School for
the Blind
 1819 Louis Braille a
student
Other senses being
used to impact the
mind


•Finger spelling
•Sister was deaf and non
verbal
•Manual Language
1745-1822
1715-1780
1105-1185
Philippe Pinel
William Cullen
Neuroses
•Coma

Four types of mental
disorders:
–
•Spasm
–
–
–
•Adynamia-lack of strength
Later: Mania without
delerium
Manie sans délire: Moral
Insanity
•Vesania-Thought Disorders
• amentia-acquired or congenital
• melancholia
• mania
• oneirodynia-Nightmares
Melancholia
Mania
Dementia
Idiotism
1710-1790
1745 –1826
Philippe Pinel and Jean-Baptiste Pussin
Jean-Étienne Dominique Esquirol
Moral Treatment
Bicêtre
4000 residents
orphanage
prison
hospital

Pinel Student

Medicalization of Mental Illness

Intellectual Disability is a
Disease-1817
Salpêtrière
10,000 Women
1772-1840
1838-Intellectual Disability is not a disease but a state in
which the intellectual faculties are not developed due to lack
of education.
Moving from physical control
to psychological control.
Étienne-Jean Georget

Jean Marc Gaspard Itard
Idiopathic Vs
Sympathetic
–
–
–
–

Brain Based
Not associated with
Specific Lesions
Interaction of Heredity,
Moral and Emotional
Factors
1820: Failure in the
development of the
intellectual faculties

1795 – 1828
Physician: National Institute
of Deaf Mutes
Viktor Of Averyon-1800
1774-1838
First IEP-Sensationist

Edouard Seguin
Primary goals
–
To interest him in social
life
–
To improve his awareness
of environmental stimuli
–
To extend the range of his
ideas (e.g. introduce him
to games, culture, etc.)
–
To teach him to speak
–
To teach him to
communicate by using
symbol systems, such as
pictures and written words
Samuel Gridley Howe
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
Itard Student: Lawyer, Educator,
Physician

A specific infirmity of the cranio-spinal
axis, produced by deficiency of nutrition
in uteroand neo-nati.

Educate to Function
in Society

First School in 1840
– Salpêtrière
1812-1880
Educative View of ID
Physiological method: weakness of
the nervous system, cured through
a process of motor and sensory
training
Samuel Gridley Howe

Boston
Abolitionist
Perkins School 1829
Education
–
–
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Blind
– Deaf/Blind
- Experimental Classroom 1848
–
…the want of a natural or harmonious
development of the mental, active and moral
powers of a human being, and usually
dependent upon some defect or infirmity of his
nervous organization. …H. B. WILBUR, 1852
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1801-1876
Moral
Mental
Community based
1846 Survey-755 people
with ID 2/1000
Experimental Classroom10 students
Feeblemindedness not
Idiocy
–
State v Trait
Perkins School
Samuel Gridley Howe
“the need of some means of communication became
so urgent that these outbursts occurred daily,
sometimes hourly.”…HK
–
All great establishments in the nature of boarding
schools, where the sexes must be separated;
where there must be boarding in common, and
sleeping in congregate dormitories; where there
must be routine and formality, and restraint, and
repression of individuality, where the chores and
refining influences of the true family relation cannot
be had, all such institutions are unnatural,
undesirable, and very liable to abuse…..Samuel
Gridley Howe, 1866.
Samuel Gridley Howe
–
Now the danger of misdirection in this pious and
benevolent work is, that two false principles may be
incorporated with the projected institutions which will
be as rotten piles in the foundations and make the
future establishments deplorably defective and
mischievous. These are. first, close congregation;
and, second, life-long association…whereas, the true,
sound principles are: separation from each other; and
then diffusion among the normal population. For
these and other reasons it is unwise to organize
establishments for teaching and training, upon such
principles as will tend to make them become asylums
for life… Even (people with ID) have rights which
should be carefully considered!....SGH 1874 .
James B. Richards-Definition
…is not a disease; it is simply the result of an
arrested development; or, as Esquirole says, “it is a
condition in which the intellectual faculties have not
been developed; or have not been sufficiently
developed to enable the person to receive the
instruction common to those of his age and station
In life.”…JBR 1856
PROGRESS
James B. Richards
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First teacher
Perkins School
Abolitionist
1852-1855
Pennsylvania
Family Home
1817-1886
Howe/Richards Approach

After the senses are trained to take note of their
appropriate objects, the various perceptive faculties are
next to be exercised. The greatest possible number of
facts are to be gathered up through the medium of these
faculties into the storehouse of memory, from whence
eventually, the higher faculties of mind may draw the
material of general ideas. It has been found difficult, if
not impossible to teach reading, by the letters first, as in
the ordinary method; but while the varied powers of the
three letters, h, a, t, could not be understood by him, he
could be made to comprehend the complex sign of the
word hat, made by uniting the three. The moral nature
needs training and development as well as his physical
and mental…..JBR 1849
J Langdon Down
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Physician
Earlswood-1858
Observations on an
Ethnic Classification-1866
Ethiopian, Mongol,
Caucasian, Malay, Native
American
Unity of Man
Classification
–
–
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Physical appearance
Personality
Heredity
1828-1896
William Ireland Etio-Medical
Classification (1877)
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Genetous
– Mongolian
– Other
Microcephalic
Eclampsic
Epileptic
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Paralytic
Cretinism
Traumatic
Inflammatory
Deprivation
Hydrocephalic
Isaac Kerlin
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Howe’s Foil
Asylum Village
Spectrum Disorder
Moral Imbecile
Eugenicist
1880-1960
1834-1893
ID Prevalence 1850-1890
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1850…….15,706*
1860…….18,865
1870…….24,527
1880…….76,895
1890…….95,571
*First Year ID separated from BH
Kerlin PA ID Survey 1871

3,500 Total
–
–
–
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717 in facilities of
substance (home or
private institutions)
604 in moderate
income families
1619 in poor families
560 in degraded homes
or almshouses
Very important in driving the creation of Psychiatric Diagnostic
Categories-DSM
AAIDD
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1876
First Professional
Organization
First Meeting at
Elwyn
Barr/Kerlin
Classification System-1904
Sloyd Workshop-Elwyn 1904
Polk State Center
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Henry H. Goddard
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1890-8,753 people
with ID in PA
1893-Commission for
a second Institution
for people with ID
1897-Began with 150
people from Elwyn
Henry H. Goddard - 1910
IQ Testing
Vineland, NJ
IQ Based Three
Tiered Classification
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–
–
Idiot (0-25)
Imbecile (26-50)
Moron (51-70)
1866-1957
Kallikak Study-Goddard (1912)
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Heredity
Criminality
Mental
Moral
Eugenics
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1883-Francis Galton
1927-Buck v. Bell
Supreme court
Virginia State Colony
for Epileptics and
Feebleminded
"Three generations of
imbeciles are
enough"… OWH
Goddard-1913
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
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In Support of Eugenics-1915
IQ tests on 346 children at Vineland each year for 3
years
“Here we may conclude that as a rule, feebleminded
children are trainable but not improvable in
intellectual capacity.”…HG 1913
I have been trying to reconcile Professor Goddard’s
statement with our definite methods of instruction.
What Dr. Goddard has just told us is the most
significant, in a way, and the most discouraging
statement that we have ever known. I am afraid it is
true.”…..Walter Fernald 1913
Two Variables-Defining ID

Conceptualization
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Medical
Psychometric
Developmental
Sociological
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1935 Meeting of AAIDD-Measure of Social
Competence
Psychology or
Pathology?
Idiopathic
Sympathetic
Doll Definition (1941)

Edgar Doll
Acquired
Congenital (Genetic)


It is the possibilities of happiness, intelligence and power that
give life its sanctity and they are absent in the case of a poor,
misshapen, paralyzed, unthinking creature. . . . The toleration of
such anomalies tends to lessen the sacredness in which normal
life is held. It seems to me that the simplest, wisest thing to do
would be to submit cases like that of the malformed idiot baby
to a jury of expert physicians.... A mental defective . . . is almost
sure to be a potential criminal. The evidence before a jury of
physicians considering the case of an idiot would be exact and
scientific. Their findings would be free from the prejudice and
inaccuracy of untrained observation. They would act only in
case of true idiocy, where there could be no hope of mental
development…….Helen Keller
Etiology
–


Social incompetence due to
Mental subnormality, which has
been
Developmentally arrested which
obtains at
Maturity is of
Constitutional origin, and is
essentially
Incurable
Charles Vaux
• 1935 Meeting of AAIDD- Shared Living
DSM-I (1952)

Three Broad Categories
–
–
–
Organic Brain Syndromes:
Down Syndrome,
Dementia, etc.
Psychogenic disorders:
Schizophrenia,
depression,etc.
Mental deficiency
DSM-I (1952)
Mental Deficiency: defect of intelligence
existing since birth, without
demonstrated organic brain disease
or known prenatal cause.
mild refers to functional (vocational)
impairment, as would be expected
with I.Q.'s of approximately 70 to 85;
moderate is used for functional
impairment requiring special training
and guidance, such as would be
expected with I.Q.'s of about 50-70;
severe refers to the functional
impairment requiring custodial or
complete protective care, as would be
expected with I.Q.'s below 50.
Heber (1959)
Heber (1961)
Subaverage general
intellectual functioning
 Originates during the
developmental period (birth
to 16 years)
 Adaptive behavior
impairment.

ID and SD
Grossman (1971)
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One standard
deviation below the
mean on an
intelligence test
<85
16% of the US
Population would fit
this criteria
Significantly subaverage
intellectual functioning
(2SD below the mean, <
70)
2.3% of the US
population should have
ID
Developmental Period=
birth to 18 years
Grossman (1977, 1983)

1977
–
–

IQs up to 10 points
above the 70 cutoff
Marked deficits in
adaptive behavior
1983
–
Two or more of the following
adaptive skill areas:
–
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

Pre 2002 definition
2002 Definition
–
–
–
1% have low adaptive
behavior and IQ less than
or equal to 70
2.5 million people
Correlation AB and IQ
=.2
First to view ID as a condition that
could be enhanced by provision
of supports, rather than as a
static, lifelong disability.
Substantial limitations in present
functioning.
Significantly subaverage
intellectual functioning.
AAIDD, 2002

Mental Retardation is a
disability characterized
by significant limitations
both in
–
–
Mental retardation manifests
before age 18.
Level of Supports-not degree of
impairment
– 2.25% have a IQ less
than or equal to 70
– 8 million people


Communication, self-care, home
living, social skills, community use,
self-direction, health and safety,
functional academics, leisure and
work.
AAIDD, 2002


Conception (instead
of birth) to age 18
Luckasson (1992)

Luckasson (1992)
–
Intellectual functioning (2
SD)
Adaptive behavior as
expressed in: conceptual,
social, and practical
adaptive skills. (2 SD)
This disability originates
before the age of 18.
AAIDD, 2008

Intellecual Disability is a
disability characterized by
significant limitations both in
–
–
–
Intellectual functioning
Adaptive behavior as
expressed in: conceptual,
social, and practical adaptive
skills.
This disability originates before
the age of 18.
DSM 5-Intellectual Developmental
Disorder-IDD

Intellectual Developmental
Disorder (IDD) is a disorder
that includes both a current
intellectual deficit and a deficit
in adaptive functioning with
onset during the
developmental period. The
following 3 criteria must be
met:
DSM 5- IDD

B) Impairment in adaptive functioning
for the individual’s age and
sociocultural background. Adaptive
functioning refers to how well a person
meets the standards of personal
independence and social responsibility
in one or more aspects of daily life
activities, such as communication,
social participation, functioning at
school or at work, or personal
independence at home or in
community settings. The limitations
result in the need for ongoing support
at school, work, or independent life.
DSM 5- IDD


The diagnosis of IDD is based
on both clinical assessment
and standardized testing of
intelligence.
In DSM-IV, mental retardation
was an Axis II diagnosis. With
the elimination of the multiaxial
classification, IDD in DSM-5 is
an Axis I diagnosis and clinical
diagnostic features require
specification.
DSM 5-Intellectual Developmental
Disorder

A) Intellectual
Developmental Disorder is
characterized by deficits in
general mental abilities such
as reasoning, problemsolving, planning, abstract
thinking, judgment,
academic learning and
learning from experience.
DSM 5-IDD

C) All symptoms must
have an onset during
the developmental
period.
DSM 5- IDD

Elimination of IQ based
Subtypes. DSM-5 does not list
mild, moderate, severe, and
profound subtypes. Instead, it
lists mild, moderate, and
severe severity levels. (Having
a profound level or
severe/profound is under
continued discussion. The
focus in the severity levels is
on adaptive functioning and not
IQ test scores.