Table 4.

Guidelines for selecting neuropsychological domains and tools for evaluation of PIMD

Assessment domain	Methods	Sources	Considerations for test administration & interpretation
Motor and Sensory	Medical record review	Developmental motor history, neurological exams, physical exams, and/or physical therapy evaluations.	Clinical assessment from medical subspecialists and allied health professionals should be incorporated
	Caregiver/parent report of motor abilities	Motor subscales of adaptive behavior measures Motor subscales of developmental assessments	Scales such as the Vineland-III, MSEL, and ABLLS-R may be informative
	Caregiver/parent report of sensory abilities	Clinical interviewing Infant/Toddler versions of standardized assessments (e.g. Sensory Profile)	Many standardized measures of sensory impairment are normed in individuals with mental and chronological ages above 36 months
Intellectual Functioning	Direct assessment	Developmental assessments	Useful in PIMD individuals with MA <48 months and limited verbal or motor abilities. Use mental AE or raw score metrics for reporting and tracking.
		Non-traditional IQ tests	Tests such as the Differential Abilities Scale –II include standard score floors as low as 25, extended norms for older individuals requiring preschool version (Elliott, 2007)
Adaptive behaviors	Parent/caregiver report	Standardized parent-caregiver report	Most standardized adaptive behavior measures lack standardization in profound range of functioning (<20)
language and Communication	Observation in natural settings	Language sampling (e.g. mean length of utterance, inventory of speech sounds)	Consider using mean length utterance (MLU) or diary/inventory of speech sounds to estimate expressive language Caregiver report forms of spoken sounds and words designed for infants and toddlers such as the MacArthur Bates Communication Development Inventory (MBCDI)
	Behavior data recording	Functional communication skills	Observation in FBA or direct assessment in curriculum-based assessments such as the ABLLS-R
	Direct assessment & caregiver report	Receptive language	Motoric limitations may impact ability to assess basic receptive vocabulary (Brady, et al, 2014)
	Direct assessment & Observation	Pre-linguistic communication	Evaluate joint attention, reciprocal imitation, symbolic play, and gestural communication (e.g. Early Social Communication Scale)
Social-communication/ASD	Direct assessment	Standardized semi-structured interview with child	Standardized measures such as the ADOS-2 are valid in individuals with MA>12–15 months; can use presses from standardized measures to inform clinical observations (see prelingustic communication above)
	Parent/caregiver report	Standardized interview with parent/caregiver	Standardized measures such as the ADI-R are valid in individuals with MA>18–24 months; can use adapted interview to inform diagnostic formulation
Behavior/psychiatric	Observation Parent/caregiver report	Standardized parent-caregiver report Clinical behavioral assessment	Some standardized measures are developed for or tested in individuals with ID. Functional behavioral assessment (FBA) are also recommended to inform diagnosis and treatment planning

ABLLS-R-assessment of basic language and learning skills, revised

ADI-R – Autism Diagnostic Interview, Revised

ADOS-2 = Autism Diagnostic Observation Scale, Second Edition

AE = age equivalent

ASD = autism spectrum disorder

ID = intellectual disability

IQ = intellectual quotient

MA = mental age

MSEL = Mullen Scales of Early Learning

PIMD = profound intellectual and multiple disabilities