When assessing intellectual disability, severity is determined primarily by adaptive functioning, particularly in conceptual, social, and practical domains, rather than by etiology or isolated mental status features. For a seven-year-old, the counselor would consider how the child:

Understands and uses concepts (e.g., time, quantity, basic academic skills).

Solves problems and learns new information appropriate to their developmental level.

Option D. Concept formation aligns with this focus on conceptual functioning, which is central to determining the severity of intellectual disability.

A. Pressured speech and B. Agitation are more associated with mood or anxiety disorders (e.g., mania, acute distress) rather than severity of intellectual disability.

C. Genetic factors may help explain the cause of the disability but do not determine its severity.

The NBCC Counselor Work Behavior Areas emphasize accurate use of diagnostic criteria and understanding that severity ratings for intellectual disability are based on everyday functioning in key domains, not just on symptoms or etiology.