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

2. Introduction
What is Mental Retardation?
Angie Covey

3. 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)

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

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

6. Degrees of Severity
Mild
Moderate
Severe
Profound

7. Let’s Take A Look

8. Prevalence and Causes
Amy Allen

9. 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%).

10. 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.

11. 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.

12. 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

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

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

15. 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.

16. 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.

17. 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.)

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

19. 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)

20. 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

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

22. Assessment
Michele Guetersloh

23. 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.

24. Intelligence Tests

25. 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.

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

27. 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.

28. 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!

29. Adaptive Skills

30. 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.

31. 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.

32. 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.

33. 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.

34. 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.

35. 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.

36. Educational Considerations
Mandy Hoelscher

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

38. 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

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

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

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

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

43. 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

44. 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

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

46. Early Intervention and Transition
Marifrances Mackey

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

48. 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

49. 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

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

51. 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

52. WHAT SERVICES MUST EACH STATE PROVIDE UNDER IDEA?

53. TRANSITION TO ADULTHOOD
Programming begins in the elementary years.

54. 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

55. Community residential facilities Supported living
LIVING ARRANGEMENTS
Community residential facilities
Supported living

56. EMPLOYMENT OF PEOPLE WITH MENTAL RETARDATION

57. 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?

58. 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?

59. VOCATIONAL TRAINING AND EMPLOYMENT
Sheltered workshop
Supported competitive employment

60. PROSPECTS FOR THE FUTURE

61. Concluding Activity
Angie Covey

62. 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

63. 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!!

64. Thank you for your Attention!!!