Mental Retardation Chapter Four Amy Allen, Angie Covey, Michele Guetersloh, Mandy Hoelscher, Marifrances Mackey

Introduction What is Mental Retardation? Angie Covey

AAMR Definition Mental retardation refers to substantial limitations in present functioning. It is characterized by significantly sub average intellectual functioning, existing concurrently with related limitations in two or more of the following applicable adaptive skill areas: communication, self-care, home living, social skills, community use, self-direction, health and safety, functional academics, leisure, and work. Mental retardation manifests before age 18. (AAMR Ad Hoc Committee on Terminology and Classification, 1992, p. 5)

Fact: About one percent of the general population has mental retardation, although some estimates range as high as three percent

Did you Know??? Mental retardation is more common in boys than in girls! It does not discriminate in who it affects!

Degrees of Severity Mild Moderate Severe Profound

Let’s Take A Look

Prevalence and Causes Amy Allen

Prevalence The average score on an IQ test is 100. Using a normal curve, we would expect that 2.27% of the population would fall two standard deviations or more below this level. The actual figures for students identified as mentally retarded are much lower (around 1 to 1.5%).

The lower figure is due to: Schools considering a broader definition of intelligence in addition to IQ scores to diagnose mental retardation. Also, schools and parents may be fore likely to identifying children as learning disabled because the term is less perceived as less stigmatizing.

The causes of mental retardation In the mid-1990s, most experts could only determine the cause in about 10 to 15% of the cases. Now, due to the mapping of the genetic code, by the Human Genome Project, experts can determine causes in a large percentage of cases.

The AAMR categorizes causes according to the time at which the cause occurs Prenatal – before birth Perinatal – at the time of birth Postnatal – after birth

Prenatal Causes Prenatal causes are grouped into chromosomal disorders inborn errors of metabolism developmental disorders affecting brain formation, and environmental influences

Chromosomal Disorders Down syndrome Williams syndrome Fragile X syndrome, and Prader-Willi syndrome.

Inborn Errors of Metabolism Results from inherited deficiencies in enzymes used to metabolize basic substances in the body, such as amino acids, carbohydrates, vitamins, or trace elements.

Phenylketonuria (PKU) The most common if the inborn errors of metabolism. Involves the inability of the body to convert phenylalanine to tyrosine; the resulting build up causes abnormal brain development. Hospitals routinely screen babies for PKU and treat it with a special diet to prevent mental retardation.

Developmental Disorders Affecting Brain formation Some are hereditary, and some are caused by conditions such as infection. Two examples are -Microcephalus - small, conical shaped head preventing proper development of brain (severe to profound mental retardation) -Hydrocephalus -enlargement of the head due to pressure of cerebrospinal fluid (degree of retardation depends on time of diagnosis and treatment.)

Environmental Influences Causes include -Maternal Malnutrition -Use of toxic agents (drugs, alcohol) -Exposure to radiation -Infections in the mother-to-be (Rubella)

Parinatal Causes Problems during birth that may lead to mental retardation include -Incorrect positioning in the uterus -Anoxia –complete deprivation of oxygen -Low birth weight -Infections passed to the infant by the mother (syphilis and herpes)

Postnatal Causes Biological causes include Traumatic brain injuries, infections (meningitis and encephalitis), malnutrition, toxins (lead) Psychosocial causes include Children raised in poor environmental circumstances and extreme cases of abuse, neglect, or understimulation

Cultural-familial Mental Retardation Mental retardation caused by an unstimulating environment and/or heredity factors.

Assessment Michele Guetersloh

Two areas are assessed to determine whether a person is mentally retarded: Intelligence Adaptive Skills To assess intelligence, a professional administers an Intelligence test to the person. To assess adaptive skills, a parent or professional who is familiar with the person responds to a survey about different adaptive skills.

Intelligence Tests

Stanford-Binet & Wechsler Intelligence Scale for Children – Third Edition (WISC – III) *Both of these tests are verbal, although the WISC-III is intended to assess both verbal and performance aspects of intelligence. *The WISC-III can be administered to derive a full scale IQ - a statistical composite of the verbal and performance IQ measures.

Kaufman Assessment Battery for Children (K-ABC) * Some psychologists recommend using the K-ABC with African American students because it is less culturally biased.

Reliability and Validity Reliability- a person will obtain relatively similar scores if given the test on two separate occasions that are not too close or far apart in time. Validity- answers the question of whether the instrument measures what it is supposed to measure.

Reasons not to base decisions on a single IQ score: Even on very reliable tests, an individual’s IQ can change from one testing to another, and sometimes the change can be dramatic. All IQ tests are culturally biased to a certain extent. The younger the child, the less valid and reliable the test. IQ tests are not the absolute determinate when it comes to assessing a person’s ability to function in society. This is why professionals also assess adaptive skills!

Adaptive Skills

Vineland Adaptive Behavior Skills Adaptive Behavior Inventory for Children AAMR Adaptive Behavior Scale-School, Second Edition AAMR Adaptive Behavior Scale – Residential and Community Edition *The basic format of these instruments requires that a parent, teacher, or other professional answer questions related to the person’s ability to perform adaptive skills.

Psychological and Behavioral Characteristics Major areas of deficit: Attention- often attending to the wrong things, persons with mental retardation have difficulty allocating their attention properly Memory- although the deficits are widespread, those with mental retardation have particular problems with their Working memory. Working memory involves the ability to keep information in mind while simultaneously doing another cognitive task. Language development- language development starts later, progresses at a slower rate, and ends up at a lower level of development --- problems with the ability to both understand and produce language.

Self-regulation - an individual’s ability to regulate his/her own behavior. Persons with mental retardation also have difficulties with metacognition. Metacognition- a person’s awareness of what strategies are needed to perform a task, the ability to plan how to use the strategies, and the evaluation of how well the strategies are working. Social development – people with mental retardation often have problems making and keeping friends.

Motivation – when people with mental retardation experience a long history of failure, they can be at risk to develop learned helplessness. Learned helplessness – the feeling that no matter how hard they try, they will still fail.

Behavioral Phenotype A collection of behaviors, including cognitive, language, and social behaviors as well as psychopathological symptoms that tend to occur together in persons with a specific genetic syndrome.

Four Genetic Syndromes that have distinctive behavior phenotypes include: Down syndrome Williams syndrome Fragile X syndrome Prader-Willi syndrome Table 4.2 (p. 126) – lists some of the major behavioral characteristics associated with these four syndromes.

Educational Considerations Mandy Hoelscher

Educational Considerations Inclusion and useful skill Self determination Instructional methods Service delivery models

Inclusion and Useful skill *teaching should be done on age appropriate level instead of the student’s mental age *without inclusion the preparation for everyday functioning with others is not established

Self Determination definition – the ability to make personal choices, regulate one’s own life, and be a self-advocate

Self Determination Four Characteristics Autonomy Self – Regulation Psychological empowerment Self – realization

Instructional Methods Students with Mild Mental Retardation Students with more severe Mental Retardation

Instructional Methods Mild Mental Retardation early elementary – readiness skills -skills deemed necessary before academics can be learned later elementary – functional academics – practical skills

Instructional Methods More Severe Mental Retardation > Systematic instruction – teaching that involves instructional prompts, consequences for performance, and transfer of stimulus control > Constant time delay – an instructional procedure whereby the teacher makes a request while simultaneously prompting the student and then over several occasions makes the same request and waits a constant period of time before prompting > Progressive time delay – an instructional procedure whereby the teacher makes a request while simultaneously prompting the student and then over several occasions gradually increase the latency between the request and the prompt

Instructional Methods Behaviors Functional Behavior Assessment – FBA – the practice of determining the consequences, antecedents, and setting events of inappropriate behavior * Positive Behavior Support – PBS – Systematic use of the science of behavior to find ways of supporting the desirable behavior of an individual rather than punishing the undesirable behavior

Placement Delivery Models range from school age to residential facilities degree of integration still needs to be determined by severity of case

Early Intervention and Transition Marifrances Mackey

EARLY INTERVENTION Programs whose purpose is to prevent retardation Programs whose purpose is to further the development of children already identified as retarded

PERRY PRESCHOOL PROJECT More had completed the twelfth grade Fewer had been arrested More owned their own homes Fewer had ever been on welfare Lower teenage pregnancy rate Earned a better-than-average income Classification as disabled or mentally retarded less likely

CHICAGO CHILD-PARENT CENTER (CPC) PROGRAM Higher school completion rates Lower juvenile arrest rates Lower rates of grade retention Lower rates of identification for special education

ABECEDRIAN PROJECT Program promoted Perceptual-motor development   Program promoted Perceptual-motor development Intellectual development Language development Social development

IDEA (Individuals with Disabilities Education Act) Part C   Minimize potential for developmental delay Reduce education costs Minimize institutionalization; maximize independence Capacity of families to meet the child’s needs Identification

WHAT SERVICES MUST EACH STATE PROVIDE UNDER IDEA?

TRANSITION TO ADULTHOOD   Programming begins in the elementary years.

Elementary DOMESTIC COMMUNITY LEISURE VOCATIONAL Junior High   Picking up toys Eating in a restaurant Playing games Cleaning room Dressing Paying for a bus ride Running Storing toys Toileting skills Shopping Tumbling Clearing dishes Junior High Washing clothes Crossing streets Playing checkers Waxing floors Cooking Purchasing a meal Cycling Bussing tables Mowing lawn Scout troop Playing baseball Following job sequence High School Cleaning rooms Banking Boating Janitorial duties Cooking meals Using health facilities Gardening Food service Maintaining personal needs Using transportation Vacation trip Laundry duties

Community residential facilities Supported living LIVING ARRANGEMENTS   Community residential facilities Supported living

EMPLOYMENT OF PEOPLE WITH MENTAL RETARDATION

Employment of People with Mental Retardation How does mental retardation affect a person’s ability to work? What kinds of jobs can people with mental retardation do? Don’t people with mental retardation need more on-the-job training and supervision than other workers? Are workers with mental retardation dependable?

Employment of People with Mental Retardation Cont. Do workers with mental retardation have more accidents on the job? Do health and other employee benefit costs go up when a company hires people with mental retardation? Do most adults with mental retardation have jobs? What is being done to help more people with mental retardation to become and stay Employed?

VOCATIONAL TRAINING AND EMPLOYMENT   Sheltered workshop Supported competitive employment

PROSPECTS FOR THE FUTURE

Concluding Activity Angie Covey

Activity: Levels of Mental Retardation Three Vignettes handout Develop lists of characteristics of individuals with mild, moderate to severe, and profound mental retardation (make one list for each of the three levels) make a list pertaining to physical appearance, academic attainment, and adult functioning Determine the level of support needed by each of the three individuals in the case vignettes Discuss characteristics made by groups and compare to the characteristics listed on “Typical Characteristics” Handout

Things to remember Individuals with mental retardation ARE individuals! Even within the IQ levels and levels of support there is still a great deal of variation! The characteristics we listed in the group activity, within the different sections covered in the PowerPoint, and in the handouts are typical, BUT ARE GENERALIZATIONS!!

Thank you for your Attention!!!