Mental Retardation & Developmental Disabilities Resource Center on Psychiatric & Behavioral Supports

Outline 1. Overview of Developmental Disabilities/Mental Retardation 2. Categories of Mental Retardation 3. Challenging Behaviors and Their Functions

The estimated prevalence… …of mental retardation in the noninstitutionalized population in the United States is people per thousand. …of developmental disabilities is people per thousand. …of combined mental retardation and/or developmental disabilities is per thousand Statistics reported by AAMR (1995)

What is a Developmental Disability?

“Developmental Disability” means either: 1) A severe, chronic disability of a person that: Is attributable to an intellectual or physical impairment or combination of intellectual and physical impairments. Is manifested before the person reaches age 22. Is likely to continue indefinitely. Results in substantial functional limitations in three or more of the following areas of major life activity: Self-care Learning Mobility Self-direction Economic self-sufficiency Capacity for independent living Receptive and expressive language

What is a Developmental Disability? Is not attributable to mental illness. Reflects the person’s need for a combination and sequence of special, interdisciplinary or generic care, treatment or other services which are of lifelong or extended duration and are individually planned and coordinated. Or… 2) A substantial developmental delay or specific congenital or acquired condition in a person from birth through age nine which, without services and support, has a high probability of resulting in those criteria listed in no. 1 later in life that may be considered to be a developmental disability. (Developmental Disability Law RS 28:451.2)

Developmental Disability Diagnoses associated with developmental disabilities include: Physical disabilities: Cerebral Palsy, Muscular Dystrophy, congenital amputations Chronic illness: AIDS, Rheumatic disease, Epilepsy, congenital heart defects, Diabetes Birth defects: craniofacial anomalies, Spina Bifida, anencephaly, myelomeningocele Sensory Disorders: auditory and visual impairments

Developmental Disability Diagnoses associated with developmental disabilities include: Cognitive Disabilities: mental retardation, communication disorders Behavioral/Emotional Disorders: Autism Spectrum Disorders Environmentally Induced Impairments: drug and alcohol syndromes and effects, physical trauma (TBI, spinal cord injury), passive environmental toxins (e.g., lead, mercury)

What is Mental Retardation?

A term used when a person has certain limitations in mental functioning and in skills such as communicating, taking care of him or herself and social skills Limitations in cognitive functioning that cause an individual to learn and develop more slowly Inappropriate reactions to one’s environment Mental Retardation is not a disease and it is not mental illness. What is Mental Retardation?

Mental Retardation Criteria for Diagnosis: Significantly sub-average general intellectual functioning IQ below 70 (two standard deviations below the mean) Significant limitations in at least 2 areas of adaptive functioning: Communication Self-care Home living Social/interpersonal skills Use of community resources Functional academic skills Onset occurs prior to age 18 (Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition, Text Revision, 2000)  Self-direction  Work  Leisure  Health  Safety

Mental Retardation Mild intellectual impairment: Impact greatest in scholastic, vocational and social domains Moderate, Severe or Profound intellectual impairment: Every aspect of living is affected essentially leaving the person unable to assume the degree of independence and personal responsibility expected for someone of his or her age

Mental Retardation Mild Impairment 85% of people with MR are classified as Mild Typically develop social and communication skills during preschool years (age 0 - 5) Minimal impairment in sensorimotor areas By late teens, academic skills are at a 6th grade level During adulthood: Achieve social/vocational skills adequate for minimum self-support May need supervision, guidance, and assistance especially when under unusual social or economic stress With supports, individuals with Mild MR can usually live successfully in the community

Mental Retardation Moderate Impairment Approximately 10% of the MR population Acquire communication skills during early childhood years Academic level up to the 2 nd grade level During adolescence - difficulties in recognizing social conventions Can carry out work and self-care tasks with moderate supervision Able to live and function successfully within the community in a supervised environment (i.e., group home)

Mental Retardation Severe Impairment Approximately 3 - 4% of the total MR population During childhood - little or no communicative speech School age period – may learn to talk and can be trained in elementary self-care skills Benefit to a limited extent from things like familiarity with the alphabet or simply counting Master skills such as sight reading some words that are necessary to complete daily tasks (i.e., stop sign, bathroom sign) Adult years – may be able to perform simple tasks in closely supervised settings

Mental Retardation Profound Impairment Approximately 1 – 2% of the total MR population Most also have a neurological condition that accounts for their mental retardation Early childhood years – display considerable impairments in sensorimotor functioning Typically need a high level of structure and supervision Motor development and self care skills may improve if appropriate training/structure is provided

What is Dual Diagnosis? What is Dual Diagnosis?

What is Dual Diagnosis? (In Developmental Disabilities) this is the co- occurrence of mental retardation and a mental disorder. Substance abuse is becoming a problem too Mental illness is 4-6 times more prevalent within the DD population

Why is it so hard to identify psychiatric conditions in people with DD? Intellectual Distortion Cognitive and communication deficits Masking of symptoms Cognitive impairment and limited personal experience Baseline exaggeration or aggravation of problem behaviors Stress worsens If psychiatric disorder is present, may see intensification Problem solving and stress management difficulties

Disturbances of Behavior Common Behavior Challenges in Persons with MR/DD Irritability Agitation Impulsivity Hyperactivity, stereotypes, tics Aggression SIB Problems sexual in nature

Functions of Behavior Why does someone act a certain way?  Escape/Avoid  Sensory  Attention  Tangible/Activity  Communication  Pain

Additional Information about People with MR/DD They may not understand what is happening or may be easily confused or frightened. They may not be able to tell you what hurts or how they were hurt, even if using language. They may respond in odd or extreme ways (e.g., screaming, running, hitting, throwing tools). They are more likely to receive medical services late in the progression of an illness. In new or unfamiliar environments, they may resist changes and have trouble following directions.

They may experience difficulty learning and thinking in abstract terms and adapting what they hear to everyday situations. They are slower to grasp ideas, and they have difficulty solving complex problems. They are 4 to 10 times more at risk of being physically or sexually assaulted within their lifetime than other adults. Additional Information about People with MR/DD

What May Be Most Helpful for Working People with MR/DD Explain things in simple, concrete ways and avoid excessive talk that can be confusing. Keep trusted family members or care givers with the person, unless refused. Try to move the person to an area with the least stimulation, noise and talk. Explain medical tools/tests before using them. Offer comforts, food, drink or other positives that may put the person at ease.

Avoid leading questions, as they may acquiesce to whatever you say or ask. If the person is not receiving services or you are unsure, ask to connect the person to the Office for Citizens with Developmental Disabilities. What May Be Most Helpful for Working People with MR/DD

References National Institute of Child Health & Human Development. National Institutes of Health Feb Feb 2006 American Academy of Family Physicians. 3 March March 2006 The Arc. 3 March March 2006 People 1 st : A Reference Guide Regarding Persons with Disabilities by the North Carolina Council of Developmental Disabilities People with Disabilities Terminology Guide by Goodwill Industries Guidelines developed by the National Easter Seals Society Best Buddies

Louisiana Office for Citizens with Developmental Disabilities Resource Center on Psychiatric & Behavioral Supports Rebecca Mandal, Ph.D., Director