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MENTAL RETARDATION MENTAL RETARDATION
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People with mental retardation were once teased and tormented. People with mental retardation were once teased and tormented.
Considered amusing, they were impersonated by court jesters and Considered amusing, they were impersonated by court jesters and comic comic
entertainers. entertainers.
People laughed at them. People laughed at them.
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Some terms applied to them were: Some terms applied to them were:
Idiots Idiots
Morons Morons
Mental Defectives Mental Defectives
Feeble Feeble- -minded minded
Fools Fools
Evolutionary Degenerates Evolutionary Degenerates
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Some religious authorities even considered them Some religious authorities even considered them changelings, changelings, possessed by the possessed by the
Devil. Devil.
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The mildly retarded were kept at home. The more severely affecte The mildly retarded were kept at home. The more severely affected were d were
institutionalized, often in dreadful conditions. institutionalized, often in dreadful conditions.
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Today they receive better care and respect, but some stigma rema Today they receive better care and respect, but some stigma remains. ins.
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Definitions of Mental Retardation Definitions of Mental Retardation
Mental retardation has become recognized as a disorder because: Mental retardation has become recognized as a disorder because:
1. 1. MR affects functioning in many aspects of everyday life MR affects functioning in many aspects of everyday life
2. 2. Children with MR may appear physically different Children with MR may appear physically different
3. 3. MR is a chronic condition, often apparent from early in life MR is a chronic condition, often apparent from early in life
4. 4. MR is world MR is world- -wide; many families have a member with MR wide; many families have a member with MR
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Percentages of children in public schools diagnosed with learning disabilities or mental
retardation, 1977 1995.
From Baumeister & Baumeister, 2000.
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DSM DSM- -IV Definition of Mental Retardation IV Definition of Mental Retardation
DSM DSM- -IV definition relies prominently, but not exclusively, on tested IV definition relies prominently, but not exclusively, on tested IQ IQ
1. 1. Mild MR, 50 Mild MR, 50- -55 to upper limit of approximately 70 IQ 55 to upper limit of approximately 70 IQ
2. 2. Moderate MR, 35 Moderate MR, 35- -40 to 50 40 to 50- -55 IQ 55 IQ
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3. 3. Severe MR, 20 Severe MR, 20- -25 (limit of testability) to 35 25 (limit of testability) to 35- -40 40
4. 4. Profound, estimated IQ below 20 Profound, estimated IQ below 20- -25 25
5. 5. MR, Severity Unspecified, usually because the person is at too l MR, Severity Unspecified, usually because the person is at too low a level to test, not ow a level to test, not
cooperative, or too young cooperative, or too young
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Recognizing the limitations of relying on IQ alone, the DSM Recognizing the limitations of relying on IQ alone, the DSM- -IV IV- -TR now includes a TR now includes a
definition nearly identical to the following definition by the A definition nearly identical to the following definition by the AAMR. AMR.
(American Association for Mental Retardation) (American Association for Mental Retardation)
MR must be present before age 18 years in all definitions. MR must be present before age 18 years in all definitions.
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The AAMR Definition of Mental Retardation The AAMR Definition of Mental Retardation
In addition to IQ, the AAMR definition considers many aspects of In addition to IQ, the AAMR definition considers many aspects of functioning, called functioning, called
adaptive behavior adaptive behavior. .
The person must show significantly sub The person must show significantly sub- -average IQ (below about 70 IQ). average IQ (below about 70 IQ).
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Must also have limitations in a least 2 or more adaptive skills Must also have limitations in a least 2 or more adaptive skills areas: areas:
Communication Communication
Self Self- -Care Care
Home Living Home Living
Social Skills Social Skills
Community Use Community Use
Self Self- -Direction Direction
Health and Safety Health and Safety
Functional Academics Functional Academics
Leisure Leisure
Work Work
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In addition to the formal diagnostic criteria, children with MR In addition to the formal diagnostic criteria, children with MR don don t expect to succeed, set low t expect to succeed, set low
personal goals, and quit early rather than struggle with tasks. personal goals, and quit early rather than struggle with tasks.
Teachers often expect little from them and don Teachers often expect little from them and don t urge them to try in reading, writing, and t urge them to try in reading, writing, and
problem solving. problem solving.
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Prevalence Prevalence
Between 1% and 3% of the population meet the criteria for Mental Between 1% and 3% of the population meet the criteria for Mental Retardation Retardation
Slightly more males than females with MR Slightly more males than females with MR
Mild MR identified more in low SES and some minority groups, esp Mild MR identified more in low SES and some minority groups, especially the ecially the
impoverished. No such differences with severe or profound MR impoverished. No such differences with severe or profound MR
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Course Course
Outlook is good for many with mild MR or Outlook is good for many with mild MR or Cultural Cultural- -familial Retardation. familial Retardation. In non In non- -academic academic
settings they can function acceptably and are not considered ret settings they can function acceptably and are not considered retarded. arded.
Appropriate training and opportunities must be provided Appropriate training and opportunities must be provided
Severe and profound MR, Severe and profound MR, Organic Retardation Organic Retardation, is lifelong, and biologically based. , is lifelong, and biologically based.
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Many people with MR are living longer; Down Syndrome patients li Many people with MR are living longer; Down Syndrome patients live up to the mid ve up to the mid- -50s on 50s on
average. average.
Issue of their care in later years, when some decline cognitivel Issue of their care in later years, when some decline cognitively due to gene damage in y due to gene damage in
those with Down Syndrome those with Down Syndrome
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Causes Causes
Mild MR is more influenced by cultural and family environment Mild MR is more influenced by cultural and family environment
More severe MR is more likely to stem from genetic and other org More severe MR is more likely to stem from genetic and other organic factors anic factors
Overwhelming evidence that both genetic and Overwhelming evidence that both genetic and nongenetic nongenetic factors powerfully affect factors powerfully affect
intelligence. Heritability of intelligence is around 50% (propor intelligence. Heritability of intelligence is around 50% (proportion of the variation of a trait in tion of the variation of a trait in
a population that is attributable to genetic influences). So int a population that is attributable to genetic influences). So intelligence is about 50% due to elligence is about 50% due to
environmental factors environmental factors
18 Factors Associated with Mental Retardation Factors Associated with Mental Retardation
19 Factors Associated with Mental Retardation (cont Factors Associated with Mental Retardation (cont d) d)
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Prenatal Development Prenatal Development
The developing fetus is naturally protected against many harmful The developing fetus is naturally protected against many harmful agents, with agents, with
some exceptions: some exceptions:
Alcohol Alcohol. Fetal Alcohol Syndrome or milder fetal alcohol symptoms. Effec . Fetal Alcohol Syndrome or milder fetal alcohol symptoms. Effects ts
range from very subtle to obvious physical defects and mental re range from very subtle to obvious physical defects and mental retardation. Not tardation. Not
known how much alcohol is too much for pregnant women known how much alcohol is too much for pregnant women
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Some illicit drugs can directly and indirectly affect the fetus. Some illicit drugs can directly and indirectly affect the fetus. Fetal addiction, Fetal addiction,
nutritional insufficiency. nutritional insufficiency.
Rubella, syphilis, herpes. Rubella, syphilis, herpes.
Untreated maternal high blood pressure or diabetes Untreated maternal high blood pressure or diabetes
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Infancy Infancy
and and
Childhood Childhood
Perinatal factors include hypoxia, intracranial hemorrhage Perinatal factors include hypoxia, intracranial hemorrhage
Injuries such as: Shaken Baby Syndrome can lead to brain injury Injuries such as: Shaken Baby Syndrome can lead to brain injury and MR and MR
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Common sequence of events in Shaken Baby Syndrome Common sequence of events in Shaken Baby Syndrome
An angry caretaker shakes a baby who won An angry caretaker shakes a baby who won t stop crying t stop crying
Weak neck muscles cause whiplash, bruising of the brain, and cau Weak neck muscles cause whiplash, bruising of the brain, and causing bleeding around sing bleeding around
the brain and behind the eyes the brain and behind the eyes
Results in apparent deep sleep. Seizures, blindness, paralysis, Results in apparent deep sleep. Seizures, blindness, paralysis, MR, sometimes death MR, sometimes death
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Prevention Prevention
Adequate prenatal care for all mothers prevents many conditions Adequate prenatal care for all mothers prevents many conditions that result in that result in
MR MR
Informing parents of the genetic basis for some types of MR Informing parents of the genetic basis for some types of MR
Effective prevention and treatment programs for maternal substan Effective prevention and treatment programs for maternal substance use and ce use and
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addiction addiction
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Public health ads to prevent pregnant women from smoking, drinki Public health ads to prevent pregnant women from smoking, drinking, doing unhealthy diets ng, doing unhealthy diets
and illicit drugs and illicit drugs
Parenting instruction for all new parents Parenting instruction for all new parents
Instruction in behavior therapy techniques for parents with chil Instruction in behavior therapy techniques for parents with children with MR and other dren with MR and other
disorders disorders
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Treatments for Mental Retardation Treatments for Mental Retardation
1. 1. Instruction Using Behavioral Principles Instruction Using Behavioral Principles
Particularly useful for MR, because they teach and maintain skil Particularly useful for MR, because they teach and maintain skills at each child ls at each child s s
level. level.
Caregivers are trained to teach children positive behaviors and Caregivers are trained to teach children positive behaviors and reduce negative reduce negative
behaviors effectively and humanely behaviors effectively and humanely
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Desired behaviors are modeled for imitation in incremental steps Desired behaviors are modeled for imitation in incremental steps, with positive , with positive
reinforcement for successful performance at each step reinforcement for successful performance at each step
Self Self- -injurious behavior is ignored and placed on extinction if mild, injurious behavior is ignored and placed on extinction if mild, followed by enforced followed by enforced
practice of better alternatives (overcorrection) if more severe practice of better alternatives (overcorrection) if more severe
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2 2. Drug Therapies . Drug Therapies
No drugs specifically aimed at MR, but some symptoms can be cont No drugs specifically aimed at MR, but some symptoms can be controlled rolled
Neuroleptic Neuroleptic drugs to reduce aggressive and antisocial behavior ( drugs to reduce aggressive and antisocial behavior (phenothiazines phenothiazines, , Haldol Haldol) )
Newer atypical antipsychotic drugs, such as Newer atypical antipsychotic drugs, such as risperidone risperidone, may be safer, but not tested for , may be safer, but not tested for
children children
Antidepressant drugs can improve sleep, possibly help reduce sel Antidepressant drugs can improve sleep, possibly help reduce self f- -injurious behavior, injurious behavior,
reduce depression. reduce depression.
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3 3. Comprehensive Early Intervention Programs . Comprehensive Early Intervention Programs
May serve children at risk because of low birth weight, prematur May serve children at risk because of low birth weight, premature birth, mild MR in the e birth, mild MR in the
family family
Expert home visitors work with the family during first 3 years o Expert home visitors work with the family during first 3 years of child f child s life s life
Mothers given instruction and practice in ways to facilitate cog Mothers given instruction and practice in ways to facilitate cognitive and social development nitive and social development
and foster good physical health. Also stress and foster good physical health. Also stress- -control for the mothers control for the mothers
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Children in daily child development center with special educatio Children in daily child development center with special education teachers and small groups n teachers and small groups
Parent support groups to help parents cope with the stresses of Parent support groups to help parents cope with the stresses of parenting parenting
Gross, Brooks Gross, Brooks- -Gunn, & Gunn, & Spiker Spiker (1992) found this program improved IQ scores, especially in the (1992) found this program improved IQ scores, especially in the
lowest birth weight group. Effects continued at 60 and 90 months lowest birth weight group. Effects continued at 60 and 90 months of age of age
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4 4. Mainstreaming . Mainstreaming
Placing children with MR in regular classrooms to Placing children with MR in regular classrooms to normalize normalize their behavior and give them their behavior and give them
more opportunities. more opportunities.
Effects are controversial. Studies show they are often shunned b Effects are controversial. Studies show they are often shunned by regular students, may not y regular students, may not
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receive the special education they need, and the poor and ethnic receive the special education they need, and the poor and ethnically different children are ally different children are
too often mistakenly identified as MR too often mistakenly identified as MR
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5 5. Institutionalization . Institutionalization
Reserved for the least capable children with the gravest disabil Reserved for the least capable children with the gravest disabilities ities
A needed service, but too often neglected and A needed service, but too often neglected and underfunded underfunded by the States by the States
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SUMMARY SUMMARY
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Mental Retardation is defined partly by an IQ score under approx Mental Retardation is defined partly by an IQ score under approximately 70 and multiple imately 70 and multiple
deficits in adaptive behavioral functioning in everyday life. deficits in adaptive behavioral functioning in everyday life.
The DSM recognizes four levels of mental retardation as measured The DSM recognizes four levels of mental retardation as measured by IQ, ranging from mild by IQ, ranging from mild
(the most frequent) to profound. (the most frequent) to profound.
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Mental Retardation can spring from many different biological and Mental Retardation can spring from many different biological and social social- -environmental environmental
factors, with the most severe forms usually having biological ro factors, with the most severe forms usually having biological roots. These include: ots. These include:
1. 1. Metabolic disorders Metabolic disorders
2. 2. Chromosomal Disorder Chromosomal Disorder
3. 3. Prenatal Infections and Toxic Substances Prenatal Infections and Toxic Substances
4. 4. Birth Injuries Birth Injuries
5. 5. Head Traumas Head Traumas
6. 6. Many Others Many Others
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Milder MR is usually treated with Milder MR is usually treated with
1. 1. Behavioral Instruction Behavioral Instruction
2. 2. Early Intervention Programs Early Intervention Programs
3. 3. Special Education Special Education
4. 4. Mainstreaming Mainstreaming
More severe MR is treated by: More severe MR is treated by:
1. 1. Behavior Therapy Behavior Therapy
2. 2. Drugs to control aggression and self Drugs to control aggression and self- -injurious behavior injurious behavior
3. 3. Either home care or institutionalization Either home care or institutionalization
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Wide availability of prenatal care for mothers and parenting ins Wide availability of prenatal care for mothers and parenting instruction could significantly truction could significantly
reduce the occurrence of MR reduce the occurrence of MR