Chapter 3

MEANING OF SPECIAL EDUCATION AND CATEGORIES OF CHILDREN

WITH SPECIAL NEEDS
To the Course Professors and Students:
Exceptional children and youth like all other pupils in regular classes are
individuals with their unique traits and characteristics. Some of them learn
slower than the average pupils, like those with mental retardation.
Meanwhile, those who are gifted and talented learn very fast and show
creativity in their work. There are exceptional children who have learning
disabilities, so that, although their mental ability is average or even above
average, they do not learn as much as they can.
Still others have sensory disabilities like blindness or low vision and
deafness; communication disorders, physical disabilities, like cerebral palsy,
spina bifida, spinal cord injuries and limb deficiency; chronic health
impairments like epilepsy, juvenile diabetes mellitus, asthma, cystic fibrosis
and hemophilia, among others.
However, in spite of their disabilities, exceptional children and youth like all
other children have the same psychological needs: they want to belong, to
be accepted, to be appreciated and to be loved. In return, they are capable
of showing appreciation, gratitude, love and friendship.
The Department of Education Special Education Division of the Bureau of
Elementary Education manages and supervises the special education
programs all over the country. Special education enables exceptional
children to study in regular schools or in special schools.
The special education teacher helps them participate in school activities
through a modified or functional curriculum.
At the end of the chapter, the students should be able to:
1. define special education and explain the meaning of individually planned,
systematically implemented, and carefully evaluated instruction for
children with special needs;
2. explain how special education enables exceptional children to benefit
from the basic education program of the Department of Education;
3. cite the difference between special education as essentially instruction
and as purposeful intervention;
4. define the terms exceptional children and youth and children with special
needs (CSN);
5. distinguish the following basic terms in special education from each other:
developmental disability, impairment or disability, handicap and at risk;
6. define, compare, and contrast the nine categories of CSN from each
other; and
7. develop positive attitudes towards exceptional children and youth.

What Is Special Education?

Current literature defines special education as individually planned,
systematically implemented, and carefully evaluated instruction to
help exceptional children achieve the greatest possible personal self-
sufficiency and success in present and future environments (Heward,
2003).
Individually planned instruction. In the United States, the law on Individuals
with Disabilities Education Act (IDEA) requires that an individualized
education program (IEP) be developed and implemented for every special
education student between the ages of 3 and 21. The basic requirements of
IDEA for all IEPs include statements of: (1) the child's present level of
performance, academic achievement, social adaptation, prevocational and
vocational skills, psychomotor skills, and self-help skills; (2) annual goals
describing the educational performance to be achieved by the end of each
school year; (3) short-term instructional objectives presented in measurable,
intermediate steps between the present level of educational performance
and the annual goals; (4) specific educational services; and (5) needed
transition services from age 16 or earlier before the student leaves the
school setting.
Systematically implemented and evaluated instruction. Each type of
children with special education needs requires particular educational
services, curriculum goals, competencies and skills, educational approaches,
strategies and procedures in the evaluation of learning and skills.
Personal self-sufficiency. An important goal of special education is to help
the child become independent from the assistance of adults in personal
maintenance and development, homemaking, community life, vocational and
leisure activities and travel.
The present environment refers to the current conditions in the life of the
child with a disability.
The present environment includes the family, the school, the community
where he/she lives, the institutions in society that extend assistance and
support to children and youth with special education needs such as the
government, nongovernment organizations, socio-civic organizations and
other groups.
The future environment is a forecast of how the child with a disability can
move on to the next level of education, from elementary to secondary school
and on to college or vocational program, and finally, to the workplace where
he/ she can be gainfully employed. Special education helps the child in the
transition from a student to a wage earner so that he or she can lead a
normal life even if he or she has a disability.

Who Are Exceptional Children or Children and Youth with Special

Needs?
Children and youth who have one or more of the conditions mentioned in the
vignettes in Chapter 1, among others, are called exceptional children. The
term exceptional children and youth covers those with mental retardation,
gift-edness and talent, learning disabilities, emotional and behavioral
disorders, communication disorders, deafness, blindness and low vision,
physical disabilities, health impairments, and severe disabilities. These are
children and youth who experience difficulties in learning the basic education
curriculum and need a modified or functional curriculum, as well as those
whose performance is so superior that they need a differentiated special
education curriculum to help them attain their full potential.
Exceptional children are also referred to as children with special needs
(CSN). Like the children and youth in elementary and secondary schools, the
mental ability of exceptional children or CSN may be average, below or
above average.
There are four points of view about special education (Heward, 2003).
1. Special education is a legislatively governed enterprise.
This point of view is expressed in the legal bases of special education that
are discussed in Chapter 1. Article IV, Section 1 and Section 5, Article XIII,
Section 11 of the 1987 Philippine Constitution guarantee that the State shall
protect and promote the rights of all citizens to quality education at all levels
and shall take appropriate steps to make such education available to all. The
State shall provide adult citizens, the disabled and out-of-school youth with
training in civics, vocational efficiency and other skills. The State shall adopt
an integrated and comprehensive approach to health and other social
services available to all people at affordable costs. There shall be priority to
the needs of the underprivileged, the sick, the elderly, the disabled, women
and children. R.A. 7277 - The Magna Carta for Disabled Persons - provides
for the rehabilitation, self-development and self-reliance of disabled persons
and their integration into mainstream society. The Philippine Policies and
Guidelines for Special Education provides that every child with special needs
has a right to an educational program that is suitable to his/her needs.
Special education shares with regular education basic responsibilities of the
educational system to fulfill the right of the child to develop his/her
potential. There are many other laws, memoranda and circulars that have
been enacted through the years in support of special education.
2. Special education is a part of the country's educational system.
Special education is a part of the Department of Education's basic education
program. With its modest historical beginning in 1907, special education is
now a major part of the basic education program in elementary and
secondary schools. The Special Education Division of the Bureau of
Elementary Education formulates policies, plans and programs, develops
standards of programs and services. There are special education programs in
public and private schools in all the regions of the country. The government
continues to grant scholarships to deserving school administrators and
teachers to pursue the graduate degrees at the Philippine Normal University
and the University of the Philippines. In-service education programs are
conducted to upgrade the competencies of administrators, teachers and non-
teaching personnel. Networks and linkages in the country and overseas are
sustained.

3. Special education is teaching children with special needs in the

least restrictive environment.
In the final analysis, teaching is what special education is all about. From
this perspective, special education is defined in terms of the who, what, how
and where of its implementation.
WHO: The exceptional children or the children and youth with special
education needs are the most important persons in special
 education. Then there are the school administrators, the special
education teachers, the regular teachers, the interdisciplinary teams
of professionals such as the guidance counselors, the school
psychologists, the speech therapists, physical and occupational
therapists, medical doctors, and specialists who help provide the
specific services that exceptional children need.
WHAT: Every exceptional child needs access to a differentiated and
modified curricular program to enable him/her to learn the skills and
competencies in the basic education curriculum. The individualized
education program (IEP) states the annual goals, the quarterly
objectives, the strategies for teaching and evaluation of learning and
the services the exceptional child needs. HOW: Children with mental
retardation are taught adaptive skills and basic academic content
that are suitable to their mental ability. Gifted children are provided
with enrichment activities and advanced content knowledge so that
they can learn more than what the basic education curriculum offers.
Most of them are in accelerated classes where they finish elementary
education in five years instead of six. Children who are blind learn
braille and orientation and mobility or travel techniques. Children
who are deaf learn sign language and speech reading.

WHERE: There are several educational placements for these children. The
most preferred is inclusive education where they are mainstreamed
in regular classes. Other types of educational placements are
special schools, residential schools, self-contained classes, home-
bound and hospital instruction.

4. Special education is purposeful intervention.

Intervention prevents, eliminates and/or overcomes the obstacles that
might keep an individual with disabilities from learning, from full and active
participation in school activities, and from engaging in social and leisure
activities. Preventive intervention is designed to keep potential or minor
problems from becoming a disability. Primary prevention is designed to
eliminate or counteract risk factors so that a disability is not acquired.
Secondary intervention is aimed at reducing or eliminating the effects of
existing risk factors. Tertiary prevention is intended to minimize the impact
of a specific condition or disability among those with disabilities. Remedial
intervention attempts to eliminate the effects of a disability.
The Basic Terms in Special Education: Developmental Disability,
Impairment or Disability, Handicap and At Risk
Developmental disability refers to a severe, chronic disability of a child
five years of age or older that is:
1. attributable to a mental or physical impairment or a combination of
mental and physical impairments;
2. manifested before the person attains age 22;
3. likely to continue indefinitely;
4. results in substantial functional limitations in three or more of the areas of
major life activities such as self-care, language, learning, mobility, self-
direction, capacity for independent living and economic self-sufficiency;
and
5.reflects the person's need for a combination and sequence of special care,
treatment or other services that are lifelong or of extended duration and
are individually planned and coordinated. (Beirne-Smith, 2002)

Impairment or disability refers to reduced function or loss of a specific

part of the body or organ. A person may have disabilities such as blindness
or low vision, deafness or hard of hearing condition, mental retardation,
learning disabilities, communication disorders, emotional and behavioral
disorders, physical and health impairments and severe disabilities. These
disabilities or impairments limit or restrict the normal functions of a
particular organ of the body. In the case of the sensory disabilities -
blindness and deafness — vision or sight and audition or hearing do not
function normally and restrict the person's seeing and hearing. The speech
mechanism is impaired in communication disorders and causes the person to
have voice problems, improper rhythm and timing in speech and even
stuttering. The skeletal and nervous systems are impaired in cases of
physical and health impairments and severe disabilities. The results are
crippling conditions, cerebral palsy and other physical disabilities.
Impairment and disability are used interchangeably.
Handicap refers to a problem a person with a disability or impairment
encounters when interacting with people, events and the physical aspects of
the environment. For example, a child with low vision or blindness cannot
read the regular print of textbooks. The child either reads books that are
published in large print or transcribed into braille. A child who is hard of
hearing or who suffers from deafness cannot hear regular conversation and
uses a hearing aid and reads the lips of the speaker. A child who has a
physical disability such as a crippling condition cannot walk normally and
uses a wheelchair, braces or artificial limbs. However, it must be
remembered that a disability may pose a handicap in one environment but
not in another. A wheelchair-bound child with a physical disability may not
be able to compete with his classmates in the Physical Education class, but
may excel in Mathematics, Science and other academic subjects.
At risk refers to children who have greater chances than other children to
develop a disability. The child is in danger of substantial developmental
delay because of medical, biological, or environmental factors if early
intervention services are not provided. Down syndrome occurs during the
early phase of pregnancy when one parental chromosome fails to separate
at conception resulting in the child's having forty-seven chromosomes
instead of the normal forty-six or twenty-three pairs. At birth, the infant has
abnormal physical characteristics and mental retardation. If a pregnant
woman contracts German measles or rubella during the first three months of
pregnancy, the fetus is at risk for blindness, deafness or mental retardation.
The fetus in the womb of a woman who consumes alcohol heavily and chain-
smokes, or takes prohibited drugs is at risk for brain injury that causes
disabilities. If a disability runs in the family, the fetus may inherit it and the
infant will be born with a disability. Children may meet accidents, suffer from
certain diseases, malnutrition and other environmental deprivations that can
lead to disabilities.

Categories of Children at Risk

Children with established risk are those with cerebral palsy, Down
syndrome, and other conditions that started during pregnancy. Children with
biological risk are those who are born prematurely, underweight at birth,
whose mother contracted diabetes or rubella during the first trimester of
pregnancy, or who had bacterial infections like meningitis and HIV.
Environmental risk results from extreme poverty, child abuse, absence of
adequate shelter and medical care, parental substance abuse, limited
opportunities for nurturance and social stimulation

What Are the Categories of Exceptionalities Among Children and

Youth with Special Needs?
1. 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 (American Association of Mental Retardation, 1992).

2. Giftedness and talent refers to high performance in intellectual,

creative or artistic areas, unusual leadership capacity, and excellence in
specific academic field (US Government). Giftedness refers to the traits of
above-average general abilities, high level task commitment, and creativity
(Renzulli, 1978). Giftedness emphasizes talent as the primary defining
characteristic (Feldhusen, 1992). Giftedness shows in superior memory,
observational powers, curiosity, creativity, and ability to learn (Piirto, 1994).

3. Specific learning disability means a disorder in one or more of the

basic psychological processes involved in understanding or in using
language, spoken or written, which may manifest itself in an imperfect
ability to listen, think, speak, read, write, spell or to do mathematical
calculations. The term includes such conditions as perceptual handicaps,
brain injury, minimal brain dysfunction, dyslexia, and developmental
aphasia. The term does not include children who have learning problems
which are primarily the result of visual, hearing or motor handicaps, of
mental retardation or of environmental, cultural, or economic disadvantages
(US Office of Education, 1977).

4. The term emotional and behavioral disorders means a condition

exhibiting one or more of the following characteristics over a long period of
time and to a marked degree, which adversely affects educational
performance: (a) an inability to learn which cannot be explained by
intellectual, sensory, and health factors; (b) an inability to build or maintain
satisfactory interpersonal relationships with peers and teachers; (c)
inappropriate types of behavior or feelings under normal circumstances; (d)
a general pervasive mood of unhappiness or depression; or (e) a tendency
to develop physical symptoms or fears associated with personal or school
problems. The term includes children who are schizophrenic (or autistic).
The term does not include children who are socially maladjusted unless it is
determined that they are seriously emotionally disturbed (US Department of
Education).
5. Speech and language disorders or communication disorders exist
when the impact that a communication pattern has on a person's life meets
any one of the following criteria: (a) the transmission and/or
46 perception of messages is faulty; (b) the person is placed at an economic
disadvantage; (c) the person is placed at a learning disadvantage; (c) there
is negative impact on the person's emotional growth; (d) the problem causes
physical damage or endangers the health of the person (Emerick and
Haynes, 1986).

6.Hearing impairment is a generic term that includes hearing disabilities

ranging from mild to profound, thus encompassing children who are deaf
and those who are hard of hearing. A person who is deaf is not able to use
hearing to understand speech, although he or she may perceive some
sounds. Even with a hearing aid, the hearing loss is too great to allow a deaf
person to understand speech through the ears alone. A person who is hard
of hearing has a significant hearing loss that makes some special
adaptations necessary (Paul and Quigley, 1990, cited in Heward, 2003).

7. Students with visual impairment display a wide range of visual

disabilities - from total blindness to relatively good residual (remaining)
vision. There is a visual restriction of sufficient severity that it interferes with
normal progress in a regular educational program without modifications
(Scholl, 1986, cited in Heward, 2003). A child who is blind is totally without
sight or has so little vision that he or she learns primarily through the other
senses, such as touch to read braille. A child with low vision is able to learn
through the visual channel and generally learns to read print.

8.Physical impairments may be orthopedic impairments that involve the

skeletal system - the bones, joints, limbs, and associated muscles. Or, they
may be neurological impairments that involve the nervous system affecting
the ability to move, use, feel, or control certain parts of the body. Health
impairments include chronic illnesses, that is, they are present over long
periods and tend not to get better or disappear.
9. The term severe disabilities generally encompass individuals with
severe and profound disabilities in intellectual, physical and social
functioning. Because of the intensity of their physical, mental or emotional
problems, or a combination of such problems, they need highly specialized
educational, social, psychological and medical services beyond those which
are traditionally offered by regular and special education programs in order
to maximize their potential for useful and meaningful participation in society
and for self-fulfillment. Children and youth with severe disabilities include
those who are seriously emotionally disturbed, schizophrenic, autistic,
profoundly and severely mentally retarded, deaf-blind, mentally retarded-
blind and cerebral-palsied-deaf (US Department of Education).
Labels and names that were derogatory were used in the past to describe
people with physical deformities, mental retardation and behavior problems.
These demeaning terms that are not used anymore are "imbecile, moron,
idiot, mentally deficient, dunce and fool." Even the words "mute" and
"dumb" are unacceptable and inappropriate to describe persons who
manifest speech and language problems as a result of deafness.
Is It Correct to Use Disability Category Labels?
There are two points of view regarding the use of labels to describe children
and youth with disabilities. The first point of view frowns on labeling these
children as mentally retarded, learning disabled, emotionally disturbed,
socially maladapted, blind, deaf or physically disabled. Use of disability labels
calls attention to the disability itself and overlooks the more important and
positive characteristics of the person. These negative labels cause the
"spread phenomenon" to permeate the mind of the able-bodied persons. The
disability becomes the major influence in the development of preconceived
ideas that tend to be negative, such as helplessness, dependence and doom
to a life of hopelessness. The truth is, persons with disabilities are first and
foremost human beings who have the same physical and psychological
needs like everybody else. They need to belong, to be loved, to be useful.
The second and less popular point of view is that it is necessary to use
workable disability category labels in order to describe the exceptional
learning needs for a systematic provision of special education services.
Nevertheless, decades of research and debates on the issue have not arrived
at any conclusive resolution of the labeling problem. A number of pros and
cons have been advanced by various specialists and educators (Heward,
2003). Pros and Possible Benefits of Labeling Categories can relate diagnosis
to specific types of education and treatment. Labeling may lead to
"protective" response in which children are more accepting of the atypical
behavior by a peer with disabilities than they would be if that same behavior
was emitted by a child without disabilities.
• Labeling helps professionals communicate with one another and classify
and assess research findings.

Part III CHILDREN AND YOUTH WITH SPECIAL EDUCATION NEEDS

Chapter 5 STUDENTS WITH MENTAL RETARDATION

"There is no one who cannot find a place for himself in our kind of world.
Each one of us has some unique capacity for realization. Every person is
valuable in his or her own existence -for himself alone.” - George H. Bender

To the Course Professors and Students:

The chapter on students with mental retardation starts with a discussion of
the different perspectives and viewpoints about the disability. A broad
definition of mental retardation is presented together with an explanation of
the factors and the assumptions on the presence of the condition. The
classification, causes and etiological factors, and the learning and behavior
characteristics of children with mental retardation are presented. The
identification and assessment procedures as well as the educational
approaches are described.
At the end of the chapter, the students should be able to:
1. explain why mental retardation is a complex developmental disability;
2. define mental retardation and explain the four factors and five
assumptions in the definition;
3. enumerate and discuss the classification of mental retardation;
4. identify and explain the causes of mental retardation during the phases of
prenatal development, the birth process, infancy and early childhood;
5. name and describe the assessment procedures to screen and assess
children with mental retardation;
6. enumerate and describe the educational approaches in teaching children
and youth with mental retardation; and
7. appreciate the fact that special education enables children with mental
retardation to develop their skills and potential. retardation to develop
their skills and potential. The professors are encouraged to arrange visits
to special schools for children with mental retardation.

Perspectives on Mental Retardation

The concepts and definition of mental retardation have changed and varied
widely in the last fifty years. Even today, the definition of mental retardation
is described as "in transition." It is expected that mental retardation will
continue to be defined in many different ways. However, common concepts
are found in the various definitions.
1.Experts and authorities agree that mental retardation is a complex
condition. In 1992, the American Association for Mental Retardation stressed
that the distinction between the terms trait and state is central to the
understanding of mental retardation.
Mental retardation is not a trait that exists separately from the other
characteristics of the individual. Rather, mental retardation is a condition or
state that affects the manner by which a person is able to cope successfully
with the demands of daily living at home, in school, in the community and
other environments. In general, the different environments are built for
normally functioning persons who have acquired the skills, competencies and
maturity through the years of normal development. The person with mental
retardation experiences difficulties in coping with the various environments
because he or she lacks the mental, emotional and social skills and
competencies to function in environments meant for normal people. But he
or she has no choice but to live, cope and function in these environments. As
a result, his or her functioning is impaired in certain specific ways.
2.Mental retardation is a developmental disability. Unlike people with
the same chronological age and average or high mental ability, the person
with mental retardation suffers from lags or delays in his or her general
development profile.
As defined in Chapter 1, a developmental disability is attributable to a
mental or physical impairment or a combination of both factors that is likely
to continue indefinitely.
3. Mental retardation results in substantial limitations in three or
more of the major activities of daily life. These are self-care, receptive
and expressive language, learning, mobility, self-direction, capacity for
independent living and economic self-sufficiency.

4.Mental retardation encompasses a heterogeneous group of people

with varying needs, features and life contexts. The previous belief was
that mental retardation was an all-or-none phenomenon. This means that
either a person was normal or had mental retardation. Now mental
retardation is viewed to exist in a continuum. The condition is accepted to be
changeable. Some persons may manifest the condition at times and not at
other times based on their needs for various levels of support.
What Is Mental Retardation?
The American Association on Mental Retardation (AAMR) had spent more
than five decades of study on what mental retardation is. The AAMR 1992
definition is the most accepted in many special education programs all over
the world.
"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
adaptive skills 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." (Heward, 2003)
Clearly, there are four criteria in the' definition which are explained below.
• Substantial limitations in present functioning means that the person
has difficulty in performing everyday activities related to taking care of
one's self, doing ordinary tasks at home and work related to the other
adaptive skills areas. The areas of difficulty include academic work, if the
person goes to school.
• Significantly sub-average intellectual functioning means that the
person has significantly below average intelligence. Intellectual functioning
is a broad summation of cognitive abilities, such as the capacity to learn,
solve problems, accumulate knowledge and adapt to new situations. The
person finds difficulty in learning the skills in school that children of his
age are able to learn. The intelligence quotient score is approximately in
the flexible lower IQ range 0 to 20 and upper IQ range of 70-75 based on
the result of assessment using one or more individual intelligence tests.

The current IQ score cutoff is 70, though it is acknowledged that IQ

scores are not exact measures, and therefore, a small number of
individuals with mental retardation may attain scores as high as 75.
Sub-average intellectual functioning indicates that intelligence, or at
least intelligence test scores, are not static or unchangeable. This current
concept assumes that one's intellectual functioning can change, and a
person diagnosed to have mental retardation at one point in life may no
longer meet the criteria or may no longer be mentally retarded at a later
time.

• Limitations in the adaptive skills or behavior show in the quality of

everyday performance in coping with environmental demands. Persons
with mental retardation fail to meet the standards of personal
independence and social responsibility expected of their chronological age
and cultural group. The quality of general adaptation is mediated by the
level of intelligence. Adaptive skills are assessed by means of standardized
adaptive behavior scales.
• Related limitations in the adaptive skills areas means that the
person has difficulty in performing the following tasks: (Beirne-Smith,
2002)
1. Communication or the ability to understand and communicate
information by speaking and writing through symbols, sign language and
non-symbolic behavior like facial expressions, touch or gestures.
2. Self-care or the ability to take care of one's needs in hygiene,
grooming, dressing, eating, toileting.
3. Home living or the ability to function in the home, housekeeping,
clothing care, property maintenance, cooking, shopping, home safety,
daily scheduling of work.
4. Community use or travel in the community, shopping, obtaining
services.
5. Social skills in initiating and terminating interactions, conversations,
responding to social cues, recognizing feelings, regulating own behavior,
assisting others, fostering friendship.
6. Self-direction in making choices, following schedule, completing
required tasks, seeking assistance and resolving problems.
7. Health and safety such as maintaining own health, identify and
preventing illness, first aid,
sexuality, physical fitness and basic safety.
8. Functional academics or learning the basic skills taught in school.
9. Leisure such as recreational activities that are appropriate to the. age
of the person.
10. Work or employment, appropriate to one's age. Mental retardation
manifests before age 18 to 22. This means that the condition can start
during pregnancy until the age of 18 to 22. A person who suffers from
brain injury at age 23 or thereafter, even if the other criteria are met,
would not be considered to have mental retardation. The reason that such
individual is excluded from this category is that mental retardation is a
developmental disability.
It is important to understand that in the diagnosis of mental retardation,
the person must meet all three of the above criteria. Thus, an IQ score
below 70 or 75, in and of itself, is not sufficient to classify a person as with
mental retardation. The person's adaptive behavior must also be impaired,
and the condition must have originated during pregnancy until the age of
18 to 22.
Mental retardation has been known by many different names that are no
longer used at present. The old labels are mentally defective, mentally
deficient, feebleminded, moron, imbecile and idiot.
In the past, a person's IQ score was the only determinant of mental
retardation. Today, several associations and agencies define mental
retardation in different ways. However, almost all of them use the IQ
score as only one criterion and usually pair it with an assessment of how
well a person can manage daily tasks which are appropriate for his or her
age.
Heward (2003) cites five essential assumptions in using the AAMR
definition:
1. The existence of limitations in adaptive skills occurs within the context
of community environments typical of the individual's age peers and is
indexed to the person's individualized needs for supports.
2. Valid assessment considers cultural and linguistic diversity, as well as
differences in communication, sensory, motor, and behavioral factors.
3. Specific adaptive limitations often coexist with strengths in other
adaptive skills or other personal capabilities.
4. The purpose of describing limitations often coexist with strengths.
5. With appropriate supports over a sustained period, the life-functioning
of the person with mental retardation will generally improve.

Classification of Mental Retardation

The criteria in the AAMR definition are very extensive, thus, a system of
sub-categories or levels of mental retardation was developed.
Traditionally, subcategories have been based on IQ ranges. In the
previous AAMR classification system, there are four levels that are still
widely used today:
1. mild MR with IQ scores from 55 to 70
2. moderate MR with IQ scores from 40 to 54
3. severe MR with IQ scores from 25 to 39, and
4. profound MR with IQ scores below 25. Current books in special
education use two classifications:
1. the milder forms of mental retardation, and
2. the more severe forms of mental retardation that cluster the
moderate, severe and profound types. The classifications "educable
mental retardation" (EMR) and "trainable mental retardation" (TMR) are
no longer used. The AAMR has introduced a new system of
classification that is based on the amount of support that the person
needs in order to function to the highest possible level.
The four categories of mental retardation according to the intensity of
needed supports are: (Wehmeyer, 2002)
1. Intermittent supports are on "as needed" basis, that is, the person
needs help only at certain periods of time and not all the time. Support
will most likely be required during periods of transition, for example,
moving from school to work.
2.Limited supports are required consistently, though not on a daily basis.
The support needed is of a non-intensive nature.
3.Extensive supports are needed on a regular basis; daily supports are
required in some environments, for example, daily home living tasks.
4.Pervasive supports are daily extensive supports, perhaps of a life-
sustaining nature required in multiple environments. Classifying
individuals with mental retardation on the basis of needed supports
makes good sense because it emphasizes the services needed by these
individuals rather than a diagnostic criterion such as an IQ score which
actually cannot translate to specific needed services. However, this
change though radical and extensive, cannot be readily adopted. It may
take many years for the classification according to needed supports to
replace the classification according to IQ scores.

Causes of Mental Retardation

There are more than 250 identified causes of mental retardation. The
AAMR classifies the causes or etiological factors based on time of onset,
categorized as prenatal or biological (occurring before birth), perinatal
(occurring during birth, and postnatal and environmental (occurring
shortly after birth) (Ad Hoc Committee on Definitions and Terminology,
1992, cited in Heward, 2003).
The specific biological causes are known for about two-thirds of
individuals with the more severe forms that include the moderate, severe
and profound types. It is important to understand that the causes listed
are conditions, diseases and syndromes that are associated with mental
retardation. These conditions may or may not result in mental retardation
or deficits of intellectual and adaptive functioning that define mental
retardation. Some of the conditions may or may not require special
education services. The term syndrome refers to a number of symptoms
or characteristics that occur together and provide the defining features of
a given disease or condition.
The environmental causes are traced to a psychological disadvantage
which is a combination of a poor social and cultural environments early in
the child's life. The term developmental retardation is used to refer to mild
mental retardation thought to be caused primarily by environmental
influences such as minimal opportunities to develop early language, child
abuse and neglect, and/or chronic social or sensory deprivation. A number
of studies illustrate the occurrence of "intergenerational progression" in
which the cumulative experiential deficits in social and academic
stimulation are transmitted to children from low socioeconomic status
environments (Greenspan, 1992).
The following factors are found to contribute to environmentally caused
mental retardation (Greenspan, et al. 1994):
1. limited parenting practices that produce low rates of vocabulary
growth in early childhood;
2. instructional practices in high school and adolescence that produce
low rates of academic engagement during the school years;
3. lower rates of academic achievement and early school failure and
early school dropout; and
4. parenthood and continuance of the progression into the next
generation.
I. Some prenatal causes, or those that originate during conception or
pregnancy until before birth are chromosomal disorders such as trisomy
21 or Down syndrome, Klinefelter syndrome, Fragile X syndrome, Prader-
Willi syndrome, Phenylketonuria, and William syndrome.
• Down syndrome, named after Dr. Langdon Down, is the best known
and well researched biological condition associated with mental
retardation. It is estimated to account for 5 to 6% of all cases.
Caused by chromosomal abnormality, the most common is trisomy 21
in which the 21st set of chromosomes is a triplet rather than a pair.
Trisomy 21 most often results in moderate level of mental retardation,
although some individuals function in the mild or severe ranges. DS
affects about 1 in 1,000 live births. The probability of having a baby
with DS increases to approximately 1 in 30 for women at age 45. Older
women are at "high risk" for babies with DS and other developmental
disabilities.
The characteristic physical features are short stature; flat, broad face
with small ears and nose; upward slanting eyes, small mouth with short
roof, protruding tongue that may cause articulation problems;
 hypertonia or floppy muscles; heart defects are common; susceptibility
to ear and respiratory infections; older persons are at high risk for
Alzheimer's disease.
• In Klinefelter syndrome, males receive an extra X chromosome.
Sterility, underdevelopment of male sex organs, acquisition of female
secondary sex characteristics are common. Males with XXY sex
chromosomes instead of the normal XY often have problems with social
skills, auditory perception, language, sometimes mild levels of cognitive
retardation. This condition is more often associated with learning
disabilities than with mental retardation.
• In Fragile X syndrome a triplet or repeat mutation on the X
chromosome interferes with the production of FMR-1 protein which is
essential for normal brain functioning. Majority of males experience mild
to moderate mental retardation in childhood and moderate to severe
deficits in adulthood. Females may carry and transmit me mutation to
their children but tend to have fewer disabilities than affected males.
The condition affects approximately one in four thousand males. It is the
most common clinical type of mental retardation after Down syndrome.
It is characterized by social anxiety, avoiding eye contact, tactile
defensiveness, turning the body away during face-to-face interactions
and stylized, ritualistic forms of greeting. Preservative speech often
includes repetition of words and phrases.
• William syndrome is caused by the deletion of a portion of the seventh
chromosome. Cognitive functioning ranges from normal to mild and
moderate levels of mental retardation. The characteristics are: elfin or
dwarf-like facial features; the physical features and manner of
expression exudes cheerfulness and happiness; "overly friendly," lack of
reserve toward strangers, often have uneven profiles of skills, with
strengths in vocabulary and storytelling skills and weaknesses in visual-
spatial skills; often hyperactive, may have difficulty staying on task and
low tolerance for frustration or teasing.
• Prader-Willi syndrome is a syndrome disorder caused by the deletion
of a portion of chromosome 15. Initially, infants have hypertonia or
floppy muscles and may to be tube-fed. The initial phase is followed by
the development of insatiable appetite. Constant preoccupation with food
can lead to life-threatening obesity if food seeking is not monitored. The
condition affects one in ten to twenty-five thousand live births. It is
associated with mild retardation and learning disabilities. Behavior
problems are common, such as impulsivity, aggressiveness, temper
 tantrums, obsessive-compulsive behavior, some forms of injurious
behavior such as skin picking, delayed motor skills, short stature, small
hands and feet and underdeveloped genitalia.
• Phenylketonuria (PKU) is one of the inborn errors of metabolism. PKU
is a genetically inherited condition in which a child is born without an
important enzyme needed to break down an amino acid called
phenylalanine found in dairy products and other protein-rich foods.
Failure to break down this amino acid causes brain damage that often
results in aggressiveness, hyperactivity and severe mental retardation.
In the United States, PKU has been virtually eliminated through
widespread screening. By analyzing the concentration of phenylalanine
in a newborn's blood plasma, doctors can diagnose PKU and treat it with
a special diet. Most children who receive the treatment early enough
have early normal intellectual development.

Developmental disorders of brain formation include cranial malformations:

In anencephaly, the major portions of the brain are absent. This is a
major neural tube defect, that is, it occurs in the brain or the spinal
cord.
• In microcephaly, the skull is small and conical, the spine is curved
and typically leads to stooped portion and severe mental retardation.
• In hydrocephaly, blockage of cerebrospinal fluid in the cranial cavity
causes an enlarged head and undue pressure on the brain.

II. Perinatal causes include:

• Intrauterine disorders such as maternal anemia, premature delivery,
abnormal presentation, umbilical cord accidents and multiple
gestation in the case of twins, triplets, quadruplets and other types of
multiple births. Birth trauma may result from anoxia or cutting off of
oxygen supply to the brain. While mental retardation still may occur
because of these conditions, improvements in fetal monitoring and
the subsequent increase in caesarean births have reduced the
likelihood of perinatal causation (Culatta et al., 2003).
• Neonatal disorders such as intracranial hemorrhage, neonatal
seizures, respiratory disorders, meningitis, encephalitis, head trauma at
birth. III. Postnatal causes include:
 • head injuries such as cerebral concussion, contusion or laceration;
• infections such as encephalitis, meningitis, malaria, German
measles, rubella;
• demyelinating disorders such as post infectious disorders, post
immunization disorders; degenerative disorders such as Rett syndrome,
Huntington disease, Parkinson's disease;
• seizure disorders such as epilepsy, toxic-metabolic disorders such
as Reye's syndrome, lead or mercury poisoning;
• malnutrition especially lack of proteins and calories;
• environmental deprivation such as psychosocial disadvantage, child
abuse and neglect, chronic social/sensory deprivation; and
• Hypoconnection syndrome.