Mental Retardation
Tuesday, July 8, 2008
MENTAL RETARDATION
Mental retardation is a triarchic disorder, characterized by subaverage cognitive functioning and deficits in two or more adaptive behaviors with onset before the age of 18. Once focused almost entirely on cognition, the definition now includes both a component relating to mental functioning and one relating to the individual's functional skills in their environment.
Alternative terms
The term "mental retardation" is a diagnostic term designed to capture and standardize a group of disconnected categories of mental functioning such as "idiot", "imbecile", and "moron" derived from early IQ tests, which acquired pejorative connotations in popular discourse over time. The term "mental retardation" has itself now acquired some pejorative and shameful connotations over the last few decades due to the use of "retarded" as an insult among younger people. This may in turn have contributed to its replacement with expressions such as "mentally challenged" or "intellectual disability".
- In North America mental retardation is subsumed into the broader term developmental disability, which also includes epilepsy, autism, cerebral palsy and other disorders that develop during the developmental period (birth to age 18.) Because service provision is tied to the designation developmental disability, it is used by many parents, direct support professional, and physicians. However, in school-based settings, the more specific term mental retardation is still typically used, and is one of 13 categories of disability under which children may be identified for special education services under Public Law 108-446.
- The phrase intellectual disability is increasingly being used as a synonym for people with significantly below-average cognitive ability.[1] These terms are sometimes used as a means of separating general intellectual limitations from specific, limited deficits as well as indicating that it is not an emotional or psychological disability. Intellectual disability may also used to describe the outcome of traumatic brain injury or lead poisoning or dementing conditions such as Alzheimer's disease. It is not specific to congenital disorders such as Down syndrome.
The American Association on Mental Retardation continued to use the term mental retardation until 2006.[2] In June 2006 its members voted to change the name of the organization to the "American Association on Intellectual and Developmental Disabilities," rejecting the options to become the AAID or AADD. Part of the rationale for the double name was that many members worked with people with pervasive developmental disorders, most of whom are not mentally retarded.[3]
In the
In England and Wales the Mental Health Act 1983 defines "mental impairment" and "severe mental impairment" as "a state of arrested or incomplete development of mind which includes significant/severe impairment of intelligence and social functioning and is associated with abnormally aggressive or seriously irresponsible conduct on the part of the person concerned."[4] As behavior is involved, these are not necessarily permanent conditions: they are defined for the purpose of authorising detention in hospital or guardianship. However, English statute law uses "mental impairment" elsewhere in a less well-defined manner—e.g. to allow exemption from taxes—implying that mental retardation without any behavioural problems is what is meant. Mental Impairment is scheduled to be removed from the Act when it is amended in 2008.
Signs
Children with developmental disabilities may learn to sit up, to crawl, or to walk later than other children, or they may learn to talk later. Both adults and children with intellectual disabilities may also exhibit the following symptoms:
- have trouble speaking
- find it hard to remember things
- have trouble understanding social rules
- have trouble discerning cause and effect
- have trouble solving problems
- have trouble thinking logically.
- persistence of infantile behaviour.
In early childhood mild disability (IQ 60–70) may not be obvious, and may not be diagnosed until children begin school. Even when poor academic performance is recognized, it may take expert assessment to distinguish mild mental disability from learning disability or behavior problems. As they become adults, many people can live independently and may be considered by others in their community as "slow" rather than retarded.
Moderate disability (IQ 50–60) is nearly always obvious within the first years of life. These people will encounter difficulty in school, at home, and in the community. In many cases they will need to join special, usually separate, classes in school, but they can still progress to become functioning members of society. As adults they may live with their parents, in a supportive group home, or even semi-independently with significant supportive services to help them, for example, manage their finances.
Among people with intellectual disabilities, only about one in eight will score below 50 on IQ tests. A person with a more severe disability will need more intensive support and supervision his or her entire life.
The limitations of cognitive function will cause a child to learn and develop more slowly than a typical child. Children may take longer to learn to speak, walk, and take care of their personal needs such as dressing or eating. Learning will take them longer, require more repetition, and there may be some things they cannot learn. The extent of the limits of learning is a function of the severity of the disability.
Nevertheless, virtually every child is able to learn, develop, and grow to some extent.
Diagnosis
According to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV),[5] there are three criteria before a person is considered to have a mental retardation: an IQ below 70, significant limitations in two or more areas of adaptive behavior (as measured by an adaptive behavior rating scale, i.e. communication, self-help skills, interpersonal skills, and more), and evidence that the limitations became apparent before the age of 18.
It is formally diagnosed by professional assessment of intelligence and adaptive behavior.
IQ below 70
The first English-language IQ test, the Terman-Binet, was adapted from an instrument used to measure potential to achieve developed by Binet in
The following ranges, based on the Wechsler Adult Intelligence Scale (WAIS), were favored at one time, but are rarely used now:
| Class | IQ |
| Profound mental retardation | Below 20 |
| Severe mental retardation | 20–34 |
| Moderate mental retardation | 35–49 |
| Mild mental retardation | 50–69 |
| Borderline mental retardation | 70–79 |
Significant limitations in two or more areas of adaptive behavior
Adaptive behavior, or adaptive functioning, refers to the skills needed to live independently (or at the minimally acceptable level for age). To assess adaptive behavior, professionals compare the functional abilities of a child to those of other children of similar age. To measure adaptive behavior, professionals use structured interviews, with which they systematically elicit information about the person's functioning in the community from someone who knows them well. There are many adaptive behavior scales, and accurate assessment of the quality of someone's adaptive behavior requires clinical judgment as well. Certain skills are important to adaptive behavior, such as:
- daily living skills, such as getting dressed, using the bathroom, and feeding oneself;
- communication skills, such as understanding what is said and being able to answer;
- social skills with peers, family members, spouses, adults, and others.
Evidence that the limitations became apparent in childhood
This third condition is used to distinguish it from dementing conditions such as Alzheimer's disease or is due to traumatic injuries that damaged the brain.
Causes
Down syndrome, fetal alcohol syndrome and Fragile X syndrome are the three most common inborn causes. However, doctors have found many other causes. The most common are:
- Genetic conditions. Sometimes disability is caused by abnormal genes inherited from parents, errors when genes combine, or other reasons. Examples of genetic conditions include Down syndrome, Fragile X syndrome, Phelan-McDermid syndrome (22q13del), Mowat-Wilson syndrome and phenylketonuria (PKU).
- Problems during pregnancy. Mental disability can result when the fetus does not develop inside the mother properly. For example, there may be a problem with the way the fetus's cells divide as it grows. A woman who drinks alcohol (see fetal alcohol syndrome) or gets an infection like rubella during pregnancy may also have a baby with mental disability.
- Problems at birth. If a baby has problems during labor and birth, such as not getting enough oxygen, he or she may have developmental disability due to brain damage.
- Health problems. Diseases like whooping cough, measles, or meningitis can cause mental disability. It can also be caused by not getting enough medical care, or by being exposed to poisons like lead or mercury.
- Iodine deficiency, affecting approximately 2 billion people worldwide, is the leading preventable cause of mental disability in areas of the developing world where iodine deficiency is endemic. Iodine deficiency also causes goiter, an enlargement of the thyroid gland. More common than full-fledged cretinism, as retardation caused by severe iodine deficiency is called, is mild impairment of intelligence. Certain areas of the world due to natural deficiency and governmental inaction are severely affected. India is the most outstanding, with 500 million suffering from deficiency, 54 million from goiter, and 2 million from cretinism. Among other nations affected by iodine deficiency, China and Kazakhstan have begun taking action, whereas Russia has not. [6]
- Malnutrition is a common cause of reduced intelligence in parts of the world affected by famine, such as Ethiopia. [7]
- Very rare conditions that are X/Y linked. In girls it can be 48, XXXX (only affecting 100 women worldwide), 49, XXXXX (only affecting 25 women worldwide) syndrome's. In boys it can be 46, XYY, 49, XXXXY, or 49, XYYYY.
Treatment and assistance
By most definitions mental retardation is more accurately considered a disability rather than a disease. MR can be distinguished in many ways from mental illness, such as schizophrenia or depression. Currently, there is no "cure" for an established disability, though with appropriate support and teaching, most individuals can learn to do many things.
There are thousands of agencies in the United States that provide assistance for people with developmental disabilities. They include state-run, for-profit, and non-profit, privately run agencies. Within one agency there could be departments that include fully staffed residential homes, day habilitation programs that approximate schools, workshops wherein people with disabilities can obtain jobs, programs that assist people with developmental disabilities in obtaining jobs in the community, programs that provide support for people with developmental disabilities who have their own apartments, programs that assist them with raising their children, and many more. The Burton Blatt Institute at Syracuse University works to advance the civic, economic, and social participation of people with disabilities. There are also many agencies and programs for parents of children with developmental disabilities.
Although there is no specific medication for mental retardation, many people with developmental disabilities have further medical complications and may take several medications. Beyond that there are specific programs that people with developmental disabilities can take part in wherein they learn basic life skills. These "goals" may take a much longer amount of time for them to accomplish, but the ultimate goal is independence. This may be anything from independence in tooth brushing to an independent residence. People with developmental disabilities learn throughout their lives and can obtain many new skills even late in life with the help of their families, caregivers, clinicians and the people who coordinate the efforts of all of these people.
Archaic terms
Several traditional terms denoting varying degrees of mental deficiency long predate psychiatry, but have since been subject to the euphemism treadmill. In common usage they are simple forms of abuse. Their now-obsolete use as psychiatric technical definitions is of purely historical interest. They are often encountered in old documents such as books, academic papers, and census forms (for example, the British census of 1901 has a column heading including the terms imbecile and feeble-minded).
There have been some efforts made among mental health professionals to discourage use of these terms. Nevertheless their use persists. In addition to the terms below, the abbreviation retard or tard is still used as a generic insult, especially among children and teens. A BBC survey in 2003 ranked retard as the most offensive disability-related word, ahead of terms such as spastic (not considered offensive in America[8]) and mong.[9]
- Cretin is the oldest and probably comes from an old French word for Christian. The implication was that people with significant intellectual or developmental disabilities were "still human" (or "still Christian") and deserved to be treated with basic human dignity. This term has not been used in any serious or scientific endeavor since the middle of the 20th century and is now always considered a term of abuse: notably, in the 1964 movie Becket, King Henry II calls his son and heir a "cretin." "Cretinism" is also used as an obsolescent term to refer to the condition of congenital hypothyroidism, in which there is some degree of mental retardation.
- Idiot indicated the greatest degree of intellectual disability, where the mental age is two years or less, and the person cannot guard himself or herself against common physical dangers. The term was gradually replaced by the term profound mental retardation.
- Imbecile indicated an intellectual disability less extreme than idiocy and not necessarily inherited. It is now usually subdivided into two categories, known as severe mental retardation and moderate mental retardation.
- Moron was defined by the American Association for the Study of the Feeble-minded in 1910, following work by Henry H. Goddard, as the term for an adult with a mental age between eight and twelve; mild mental retardation is now the term for this condition. Alternative definitions of these terms based on IQ were also used. This group was known in
- In the field of special education, Educable (or "educable mentally retarded") refers to MR students with IQs of approximately 50-75 who can progress academically to a late elementary level. Trainable (or "trainable mentally retarded") refers to students whose IQs fall below 50 but who are still capable of learning personal hygiene and other living skills in a sheltered setting, such as a group home. In many areas, these terms have fallen out of favor in favor of "severe" and "moderate" mental retardation.
- Usage has changed over the years, and differed from country to country, which needs to be borne in mind when looking at older books and papers. For example, "mental retardation" in some contexts covers the whole field, but used to apply to what is now the mild MR group. "Feeble-minded" used to mean mild MR in the
- Along with the changes in terminology, and the downward drift in acceptability of the old terms, institutions of all kinds have had to repeatedly change their names. This affects the names of schools, hospitals, societies, government departments, and academic journals. For example, the Midlands Institute of Mental Subnormality became the British Institute of Mental Handicap and is now the British Institute of Learning Disability. This phenomenon is shared with mental health and motor disabilities, and seen to a lesser degree in sensory disabilities.
TITLE: Numbers & Numerals
PURPOSE: The Numbers/Numerals lesson plan focuses on the development of number recognition, number discrimination, number counting, rational counting, and number recall skills.
RATIONALE: Develop prerequisite for prevocational number recognition & counting skills.
ANNUAL GOAL:To improve number & numeral discrimination and counting skills.
INTENTIONAL TARGET SKILLS: Attention, number recognition/identification, number discrimination, number and numeral matching, shape identification, shape discrimination, matching-to-sample, counting shapes (rote and rational), visual memory, and visual recall.
INCIDENTAL TARGET SKILLS:Finger dexterity, visual scanning, visual discrimination, directionality (left-right progression).
SHORT-RANGE OBJECTIVE: S will match the ___ (one, two, three-digit) number to its duplicate located in a group of one or more numbers, with __% accuracy, within __seconds of request.
(Fill in blanks to match objective to student current functioning level on the task.)
SKILLS TRAINED/PRACTICED: Simultaneous discrimination and match-to-sample skills; Attention; CRF reinforcement schedule; Means-end behavior; Generalization (across-task).
PREREQUISITES: Fine motor dexterity; receptive language; self-control, FACTS+ Cause/Effect Disk.
MATERIALS: Apple IIe/clone w/64K RAM; cardboard color monitor 1 or 2 disk drives; FACTS+ Numbers/Numerals lesson
NOTES: (1) The teacher can tape a cardboard flap to the computer to cover up all keys but the number keys. (2) If necessary, also use a cardboard flap to cover the ESC key.
FEATURES: What features are available? (1) Cursor on/off? Again, the fact is that some users may be distracted by a blinking cursor. If so, can it be toggled on/off? (2) Is there an option to disappear the display after a set time? If so, once again the flexibility or scope of the exercise is multiplied. If the display can be manipulated, our experience suggests that the teacher leave the number displayed during initial lessons, if only to ensure high rates of task success. Later on, we suggest you opt to remove the displayed number. Removing the number before allowing the user to enter a response provides excellent training on memory and recall. (3) Is there automatic branching, so that the student can move on to a more difficult level?
SUGGESTIONS: (1) Cardboard strips. As the late great Swiss psychologist, Piaget, has taught, very often "Out of sight is out of mind" when working with youngsters. Suppose a user encounters problems locating and then pressing the correct number key, whether along the top row or on the numeric keyboard of the newer Apple IIe, Laser, DOS, Windows, or Mac computers. In such cases, we suggest that you cover the rest of the keyboard below the top row of keys with a thin cardboard strip, about 12.5 long and 7.5 wide.
To do this, wrap all but 1 wide of the entire cardboard strip in heavy-duty tape. (We use silver-colored duct tape, available in most stores that sell household or hardware goods [e.g. K-Mart]). Then, fold over the uncovered 1 of cardboard and tuck the now-folded edge down between the row of keyboard numbers and the top row of letters. The other edge of the cardboard strip is then pulled down across and over the keyboard, so that all but the row of numbers is covered. Tape the lower edge or lip of the cover to the underside of the keyboard, again using the duct tape.
The newer, so-called platinum Apple IIe computers, Lasers, IBMs, and clones feature a separate numeric keypad. With these computers, cover the entire main keyboard, leaving only the numeric pad on the right-hand side of the computer free and visible for use. We have found that hiding the rest of the keyboard in this way makes the task of number identification and discrimination much easier. As the learner progresses, of course, the rest of the keyboard can in time be gradually and systematically uncovered.
In similar fashion, you may initially wish also to use small bits of silver duct-type tape to cover the symbols (e.g., !,@,#,$,%,^,&,*,(,) located above the number on the numbered keys. Again, a dab of Krazy-glue atop each attached piece of tape will prevent busy fingernails from peeling off the handiwork.
(2) Enlarge Numbers. If the learner struggles to locate the keyboard number required to match the number on the screen, consider the following: Cut a second, narrower, strip of cardboard, tape it immediately above the row of numbers and with a thick Magic Marker pen print in LARGE type the number of the key on the cardboard strip directly above the number on the key. The learner can then more easily spot the LARGE-size correct number printed on the cardboard strip and match it to the same number appearing on the keyboard row directly below. (Of course, this suggestion applies to the main rather than numeric keyboard.)
(3) Color-code Numbers. If additional prompts are needed, try color-coding the numbers. Purchase small-brand model toy paint in a variety of colors. Then, put a small dab of each paint color on a corner of each number key. Be sure that each of the number keys displays a different color. Then, when the color has dried, cover the colored area with a small dab of instant bonding (Krazy) glue. Coating each painted area in this way provides excellent protection against the wear and tear from eager key-tapping fingers! (Oh yes, the glue will also keep the user from successfully peeling or picking the color off a key.)
Color-coding the number keys adds a practical dimension to the instructional process. Specifically, the colors add a built-in (within-stimulus) prompt. Hence, when the learner has problems matching numbers, the teacher can say,
“Press RED....Good! Red is 1...What NUMBER is red? ... Good. ... Red is 1.
GREAT work!”
(4) 0. The number zero looks nearly identical to the large oh (O). For lower functioning computer users, the discrimination may be a difficult task indeed. Not surprisingly, then, one can expect many youngsters to encounter difficulty distinguishing the two. Suggestion: With a thin-pointed indelible black ink pen, run a upper right to lower left diagonal slash (/) through the zero on one or board zero keys. Later, of course, as the user's visual discrimination skills develop, fade out the within-stimulus prompt with a dash of acetone or finger-nail polish remover.
(5) Flashcards. A strategy we have found helpful in training number discrimination is to include number flashcards with this lesson. The teacher might say, for example, Put 1 with 1, or Put red with red, or Put same with same (if a number card is held by the teacher). The user selects the correct number card and physically places it over the number (or numeral) which appears on the screen. (The reader is referred to the Match-to-Sample Classroom lesson for detailed suggestions regarding the use of flashcards.)
(6) Counting. Prompt the more advanced users to count each shape in varying units. The shapes will probably initially be counted in single units; later on, however, try counting by 2s, 5s, etc depending on the functioning level of the user. For very high functioning users, the shapes can be used as a basis for counting backwards as well as forward. Also, addition and sub- traction skills can be improved by use of the shapes which appear on the screen.
SUMMARY: A powerful set of skills, both intentional and incidental, are addressed in this lesson, single and multi-digit number recognition and match- ing are emphasized. Moreover, visual memory skills may be practiced, using the display delay option built into the lesson.
Posted byDoc Junhel at 3:31 PM
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