IDD-MH Prescriber Guidelines

Abilities Based on Level of IDD

Originally developed by Jill P. Hinton, PhD (2016); Revised February 2020.

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Conceptual Domain

(learning, abstract thinking, planning, flexibility, memory, strategizing, academic skills)

Social Domain

(language, communication, social skills)

Practical Domain

(personal care, employment, health care and legal, recreation, transportation, shopping, money management)





  • There may be no obvious conceptual difference in early childhood
  • Difficulties learning academic skills
  • Impaired executive functioning, abstract thinking, short term memory
  • Concrete approach to problem solving
  • Immature in social interactions
  • Communication, conversation, and language are concrete
  • Difficulty regulating emotions and behavior
  • Impaired social judgment and limited understanding of social risks
  • Develops friendships and romantic relations in adulthood
  • May function independently in personal care
  • Need support in complex daily living tasks
  • May live semi-independently with support in money management, transportation, organization of household tasks.
  • Competitive or supported employment.
  • Support needed for health care decisions and childcare







  • Throughout development, conceptual skills behind those of peers
  • Academic skills develop slowly and limited compared to peers
  • Adult academic skills at elementary level
  • Support needed for conceptual tasks of day-to-day life
  • Marked difference from peers in social and communicative behavior across development
  • Spoken language used, but much less complex than peers
  • Capacity for successful friendships and romantic relations in adulthood
  • Social judgment and decision making are limited
  • Significant social and communicative support needed in work settings
  • Can learn to care for personal needs but may need extended period of teaching
  • May need reminders, schedules life-long
  • Employment with considerable support to manage social expectations and job complexities
  • Require support for scheduling, transportation, health issues, and money management
  • Typically require additional support and learning opportunities over extended period of time





  • Attainment of conceptual skills is limited
  • Little understanding of written language or math/money concepts
  • Need extensive support for problem solving throughout life
  • Spoken language is limited
  • Speech may be single words and phrases
  • Language is focused on here and now
  • Relationships with family and familiar others are a source of comfort and help
  • Requires support for all activities of daily living
  • Needs significant support in making decisions about well-being of self or others.
  • Long-term teaching and support required for participation in home, recreation, and work.






  • Conceptual skills generally involve physical world rather than symbolic processes
  • May use objects is goal-directed way
  • Visual spatial skills such as sorting and matching may be acquired
  • Co-occurring motor and sensory impairments may also affect ability to use objects in s functional way
  • Limited understanding of symbolic communication
  • May understand simple instructions and gestures
  • Expresses desires through nonverbal, non- symbolic communication.
  • Enjoys relationships with well-known family members and familiar others
  • Dependent on others for all aspects of daily physical care, health, and safety
  • May assist with simple work tasks at home
  • Simple actions with objects may be basis of involvement in vocational activities
  • Recreational and leisure often involve sensory activities – music, walks outside, water activities – with support from others.
  • Co-occurring motor and sensory impairments may be barriers to participation



1 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: American Psychiatric Association; 2013.