Identifying learning disabilities

Several years ago I was speaking with the head of healthcare at a north London prison about the abilities of their inmates. I attended to assess, as was often the case, those with possible learning disabilities.

However, he offered the opinion that around 40 per cent of the inmates had an IQ below 80. That is, those with an IQ within the lowest 9 per cent of the population made up 40 per cent of the inmates. We now have evidence from other countries to suggest that this is indeed a true reflection of the prison community. It also suggests an issue for the court and its processes.

In practical terms, one has to consider what an IQ of 80 or less looks like.

• First, based on the IQ score, one can predict they will be illiterate and as such, unable to read and understand the documents of the court, or more specifically, witness statements.

• Second, based on the IQ score, it is more likely than not their receptive language skills will impair their ability to fully or adequately understand much of what needs to be discussed.

• Third, their reasoning skills are weak, meaning their ability to challenge the evidence will be weak, failing to understand it, its implications, and the relationship between one piece of evidence and another.

• Fourth, IQ tests typically predict educational and occupational success with remarkable accuracy and as such, show a consistency in functioning over the life course. In my view, these four features impact on the ability of those with low IQ to adequately address the issues at court.

However, the ability of professionals to identify those with low intelligence so appropriate support is available is the challenge. The defendants may, for example, need more breaks to discuss the ongoing proceedings with their defence teams. They may need a registered intermediary who can help them both understand the questions posed and express their views adequately. Of course, if the level of intelligence and 'cognitive functioning' falls low enough, the court may need to decide if the defendant is able to offer a plea and a defence.

If one wishes to quickly identify a person with low IQ or possible learning disability there are six assessments that can be made.

1. Have you ever had special education/classes/lessons at school?

Any answer in the affirmative indicates they probably fell into the lowest 10 per cent of the school population. If they had at least five hours of one-to-one support or teaching, they probably fell into the lowest 5 per cent (IQ score of 75 or less), and if they attended any special unit, they fell into the lowest two per cent (IQ score of 69 or less).

In all cases an assessment would be beneficial as it is more likely than not they will require some support during the court process.

2. How many GCSEs did you pass?

GCSEs have been the qualification used since the 1980s and as such, many of those aged in their 40s will have attempted them.

Initially, ask about the number of 'C' grades or better, because 50 per cent of the school population achieve at least five 'C' grades.

If the defendant has less than five, they fall into the lowest 40 per cent to 50 per cent. If they have one or two 'C' grades or less, it is almost certain they fall into the lowest 10 per cent of the population. If they have no GCSEs at any grade, they fall into the lowest 2 per cent of the population.

If they have had some special education, and/or achieved very few GCSEs ask the following:

3. Name the days of the week

Very few people do not know the days of the week. They are taught in all schools from the age of four to five years and as such, if the defendant does not know the answer, they probably require an assessment, and in my experience, may have an IQ below 60 (lowest 0.5 per cent).

4. Name the months of the year

If they do not know the months of the year, they probably have an IQ below 80.

5. Count backward from 25

This requires the person to know and fully understand the relative position of numbers. If they cannot do this task or it takes more than 30 to 40 seconds, it indicates a failure to understand. It suggests their IQ will be below 80.

6. Name the alphabet

If they attended a special school, they will probably make no more than one or two mistakes. If they did not attend a special, and they cannot do this, their IQ will almost certainly be below 80.

In my experience, these six areas will indicate to the legal professional if the defendant needs a psychological assessment, and if they failed on three of these last four areas, suggests they probably have an IQ below 70. This information allows the defendant to be supported during the court process and increases their understanding of events in which they are taking part.

Graham Rogers is a consultant psychologist, former consultant for the NHS

info@grahamrogers.org.uk