This post is more speculative, and an exploration into current research, than a tried and true ABA topic I usually expound on. I saw something that struck me this morning on Twitter. The claim that an individual with an IQ less than 80 could not be trained to functionally work in society. I know for a fact this is not the case, because I’ve seen and worked on it, but I wanted to get my sources down to confront this Tweet.

It was harder than I expected.

I wanted a single consensus of an answer, but unfortunately could not find one. I think I know why, and the answer does not specifically have to do with the IQ scores of the participants, it has to do with how that training is done in relation to the population. We’ll touch on the details of that below.

I have personally worked on hundreds of Applied Behavior Analytic cases, with a broad range of ages, abilities, intelligence, and skills. I have seen more success than I have plateaus. I’ve seen employment aids and training work. The challenge of the process is certainly true, but I dislike the idea of firm impossibilities. This may influence how I first took affront to that Tweet. The research is vast, but the narrative I’ve come to understand does not simply allow an IQ score to determine a cut off for functionality in the workplace. Not exactly. Let’s look at the research I was familiar with:

 

Rusch & Hughes (1989) in the Journal of Applied Behavior Analysis-  “An Overview of Supported Employment”. They used the common term “Supported Employment” for individuals with disabilities and were focused mainly on those individuals sustaining paid work. The paid work part was fairly important to them, and I’d argue that maintaining paid employment is a reasonable counter to the claim that training is ineffective with the target populations. This study did explore the “place and train” model, which later studies found to be less than optimal, but the findings here did find a measure of success. Some individuals did benefit from these methods. That’s the important finding. They were able to sustain paid work in society. Their terminology for intelligence scoring is a little outdated in this study. We use the term Intellectual Disability these days. They used the terms “mentally retarded”- “mildly”, “moderately”, and “profoundly” specifically. Looking up the diagnostic criterion used at the time, we can see that Rusch and Hughes had the following distribution:

Out of 1,411 individuals with disabilities sustaining paid employment, 8% of these individuals fell within the “mentally retarded” category with IQ scores below 70.

• 10% of these individuals fell within IQ score ranges of 20-25 (“profoundly mentally retarded”)
• 45% of these individuals fell within IQ score ranges of 35-55 (“moderately mentally retarded”)
• 38% of these individuals fell within IQ score ranges of 50-70 (“mildly mentally retarded”)
• <8% of these individuals fell within IQ score ranges of 70-80 (“borderline mentally retarded”)

So, even with outdated “place and train” models, this study does give us some information on some level of effectiveness that supported training can meet the criterion and disprove the Tweet, and this was as of 1989 referencing successes from decades prior. There are a place for individuals with a vast range of intelligence scores in society. Problem solved, right?

Wait just a minute. There are some challenges in the training process that can not be overlooked. Challenges that might just hint at why people believe that supported training does not work. We see in Rusch and Hughes the successes of certain methods for a small amount of the population. Since then, we’ve seen some longitudinal studies that have raised more questions than they’ve given us answers, and raised more challenges than we thought were there.

 

Conroy & Spreat (2015)- Journal of Policy and Practice in Intellectual Disabilities

Conroy and Spreat titled their study a “Longitudinal Investigation of Vocational Engagement”, and were interested in how individuals with intellectual disabilities remained employed during a 15 year period from 1999-2004.

An important point I want to bring up first is the concept of Self-Determination, which is the point which all people have to make choices about their lives. An individual, no matter their situation, can make choices about their own lives freely. That includes employment. So when we speak about supported employment, this is due to the individual wanting to work, and maintaining that employment freely.

What Conroy and Spreat were studying were vocational attendance, and quality-of-life data. They found a similar trend in individuals receiving both residential supports and day-to-day supports:

“The overall amount of vocational, prevocational, and nonvocational activities changed sharply during the 15‐year period. Vocational and prevocational activity declined, while nonvocational engagement more than doubled, both in numbers of people and hours. During the same time period, the number of employed individuals consistently declined, as did the total number of hours worked.”- (Conroy and Spreat, 2015)

So we see a trend here where worked hours decrease over time, and nonvocational engagement increased with the studied population. Why could that be? According to Conroy and Spreat, it was due to “segregated forms of vocational activity”. These individuals were not in society working side by side as we saw in the older “train and place” method with Rusch and Hughes, they were doing workshops and prevocational activities separately. Those factors, according to Conroy and Spreat, seemed to have a large effect on the downturn of worked hours.

Again, I see a theme here. The individuals themselves had no innate limitation to working those hours, but the vocational training and workshops appeared to play a role in either the disinterest in maintaining employment, or maybe it was not a good fit for those individuals for that particular skill. That system of separating out workshops and prevocational skills from inclusion with the broader population just did not seem to be effective. So, what is an alternative?

Lattimore & Parsons (2006)- Journal of Applied Behavior Analysis article titled “Enhancing Job-Site Training of Supported Workers With Autism: Reemphasis on Simulation” was a great find. It had everything I was looking for. I wanted to seek out a (evidence based) reasonable solution that had individuals in the work place (job-site), engaging with the broader population, and had a degree of success. But, they came up with a challenge (and solution to) I had not seen before: Job-Site training alone is sometimes insufficient for quick skill acquisition. Simulation (prevocational training, like what we see used in Conroy and Spreat) added in to the job-site supports seemed to be the key to speeding that acquisition up.

“Job-site training occurred in a small publishing company during the regular work routine, and simulation training occurred in an adult education site for people with severe disabilities. Two pairs of workers received training on two job skills; one skill was trained at the job site and the other was trained using job-site plus simulation training. Results indicated that for 3 of the 4 comparisons, job-site plus simulation training resulted in a higher level of skill or more rapid skill acquisition than did job-site-only training. Results suggested that job-site training, the assumed best practice for teaching vocational skills, is likely to be more effective if supplemented with simulation training”- (Lattimore and Parsons, 2006)

In this study, adults with severe disabilities (the DSM-V IQ score for this population is 25-40) were tested in conditions where on-site community employment training and support were given. Interestingly, both were effective, but skill acquisition was much faster when simulation (off site training) was provided as well. This combination was a fascinating read for me, because it tied some of the factors that the previous two studies saw as challenges.

There is a mountain of research out there, and this just scratched the surface, but this exploration did seem to reinforce my original anecdotal belief that an IQ score alone is an insufficient barrier, and shows an ignorance to the power of effective training and applied behavioral therapy. This is a complex problem, and one I might not have been able to boil down into a single tweet, but one I am happy to see researchers coming up with solutions to every day.

 

Thoughts? Comments? Leave them below.

 

Sources:

Lattimore, L. P., Parsons, M. B., Reid, D. H., & Ahearn, W. (2006). Enhancing Job-Site Training of Supported Workers With Autism: A Reemphasis on Simulation. Journal of Applied Behavior Analysis, 39(1), 91-102.

Rusch, F. R., & Hughes, C. (1989). Overview of supported employment. Journal of Applied Behavior Analysis, 22(4), 351-363. doi:10.1901/jaba.1989.22-351

Spreat, S., & Conroy, J. W. (2015). Longitudinal Investigation of Vocational Engagement. Journal of Policy and Practice in Intellectual Disabilities, 12(4), 266-271. doi:10.1111/jppi.12136

 

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