Typical adaptive needs and supports according to severity of intellectual disability

Severity level		Adaptive skill domains
DSM-5 categories	AAIDD categories	Conceptual	Social	Practical
Mild	Intermittent	Children require academic supports to learn skills expected for age. Adults may have difficulties with functional academic skills such as planning, reading, and money management.	Social skills and personal judgement are immature for age. The individual is at risk of being manipulated by others (gullibility).	Most individuals achieve independence in daily living and personal care activities; most are employable in jobs requiring simple skills and are often able to live independently. They typically need support for making decisions in health care, nutrition, shopping, finances, and raising a family.
Moderate	Limited	For children, conceptual and academic skills lag well behind those of peers. For adults, academic skills are typically attainable at an elementary level. Complex tasks such as money management need substantial support.	Successful friendships with family/friends are possible using simple spoken language, but the individual is limited by deficits in social and communicative skills. Social cues, social judgment, and social and life decisions regularly need support.	Most individuals are capable of personal care activities with sufficient teaching and support, and achieve independent self-care with moderate supports, such as is available in a group home. Adults may be employable in a supported environment.
Severe	Extensive	Individuals have little understanding of written language, or number, time, and money concepts. Caretakers provide extensive supports for problem-solving.	Individuals benefit from healthy supportive interactions with family/familiar people and may use very basic single words, phrases, or gestures pertinent to their direct experience.	Individuals are trainable in some basic activities of daily living with significant ongoing support and supervision.
Profound	Pervasive	Individuals may use objects in a goal-directed fashion for self-care and recreation.	Although understanding of symbolic communication is very limited, individuals may understand some gestures and emotional cues, and can express themselves nonverbally.	Individuals are typically dependent upon support for all activities of everyday living. Co-occurring sensory or physical limitations are common.

This table provides examples of typical adaptive needs and supports according to the severity of ID. The severity of ID is defined by the level of adaptive impairment and the level of support needed. The American Psychiatric Association's DSM-5 categorizes adaptive impairment from mild to profound.^[1] The AAIDD uses categories of intermittent, limited, extensive, and pervasive.^[2] Supports are wide-ranging and aim to optimize the functioning, participation, and independence of the child in everyday environmental settings, including home, school, community. Profoundly impaired children usually require pervasive support.

ID: intellectual disability; DSM-5: Diagnostic and Statistical Manual, 5th Edition; AAIDD: American Association on Intellectual and Developmental Disabilities.

Adapted from the following sources:

American Psychiatric Association. Intellectual Disability (Intellectual Developmental Disorder). In: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, American Psychiatric Association.
American Association of Intellectual and Developmental Disabilities (AAIDD). Definition of Intellectual Disability. Available at: http://aaidd.org/intellectual-disability/definition (Accessed on July 17, 2018).

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Typical adaptive needs and supports according to severity of intellectual disability