copyright 2008 Cheryl K. Hosken, BSN, MS Psych.
Objectives:
- The student will understand the history of treatment for mental retardation.
- The student will know the causes of mental retardation.
- The student will understand the characteristics of mental retardation.
Child Profile
Ryan, a 16-year-old tenth grader who has Down's Syndrome, turns off his alarm clock at 6:15 A.M. Monday morning and barges into his parents' room, "I up by myself," he says. Then he asks his parents the daily question, "Ryan have school today?" His mother assures him, "Yes, this is a school day." Ryan replies, "I excited!"
After microwaving and eating his favorite breakfast - 2 pieces of leftover pizza - Ryan goes to the bathroom to shower and shave. He uses an electric razor for shaving. Then he starts his shower. Turning the water to the correct temperature is tricky for him.
At school, Ryan hangs out with the kids before classes start. Just before the bell rings, Ryan sees his his friend Matt and tries to hug him. Matt pushes Ryan back and says, "Stop that, Ryan and give me a "high 5" (handshake) instead. And don't try to hug the girls either!" Learning appropriate social skills has been a struggle and Ryan needs to be with peers to help him.
In his media class, Ryan's goals are modified from the general curriculum. Today, while his peers learn about different parts of the newspaper, Ryan learns to locate and read the date, weather and movie information. The rest of his day is spent in special education classes for students with moderate mental retardation. Ryan learns academic and social skills that will help him live independently as an adult. He learns to negotiate for what he wants instead of making demands. He learns to give reasons for the choices he makes.
Before the school day ends, Ryan takes the bus to the fire station #3. There he meets his job coach (a person who teaches him all the duties of his job) and gets his assignment for the afternoon. Today, he will wash and wax the fire trucks. Tomorrow, he'll vacuum and sweep the station. He likes to work alongside the fire fighters. He wants to be accepted by them and be proud of the work he does. In 2 hours, he takes the bus home and groans when he finds that he has to go shopping for clothes with his mom. They look at shirts for him with snaps. Buttons are a little hard for him to handle.
Back home, Ryan and his brother argue about the Nintendo game and Ryan appeals to his mother to help him because brother Josh won't give up the game. His mother says, "Work it out among yourselves." After dinner, Ryan clears the table and puts the dishes in the dishwasher and he watches T.V. for an hour. Then he gets ready for bed and has a man-to-man talk with his father.
Meditate Word By Word On These Verses:
1 Corinthians 12:20-25.
History of Mental Retardation
Mental retardation is an idea, a condition, a syndrome, a symptom, and a source of pain and bewilderment to many families. Its history dates back to the beginning of man's time on earth. The idea of mental retardation can be found as far back in history as the therapeutic papers of Thebes (Luxor), Egypt, around 1500 B.C. Although somewhat vague due to difficulties in translation, these documents clearly refer to disabilities of the mind and body due to brain damage.
Mental retardation is also a condition or syndrome defined by a collection of symptoms, traits, and/or characteristics. It has been defined and renamed many times throughout history. For example, feeblemindedness and mental deficiency were used as labels during the end of the last century and in the early part of this century.
All definitions of mental retardation include difficulties in learning, social skills, everyday functioning, and the age of onset is during childhood. Mental retardation has also been used as a defining characteristic of other disorders such as Down's Syndrome and Prader-Willi syndrome. Finally, mental retardation is a challenge and potential source of stress to the family of an individual with this disorder. From identification through treatment or education, families struggle with questions about cause and prognosis, as well as guilt, a sense of loss, and disillusionment about the future.
During the Middle Ages (476 - 1799 A.D.) the status and care of individuals with mental retardation varied greatly. Although more humane practices evolved (i.e., decreases in infanticide and the establishment of foundling homes), many children were sold into slavery, abandoned, or left out in the cold.
Toward the end of this era, in 1690, John Locke published his famous work entitled An Essay Concerning Human Understanding. Locke believed that an individual was born without innate ideas. The mind is blank and experiences cause the mind to mature. This theory would profoundly influence the care and training provided to individuals with mental retardation. He also was the first to distinguish between mental retardation and mental illness: "Herein seems to lie the difference between idiots and madmen, that madmen put wrong ideas together and reason from them, but idiots make very few or no propositions and reason scarce (hardly) at all."
Jean Marc Itard was probably the most important physician who changed ideas about the care of the mentally retarded. He was hired by the National Institutes of France to work with people who were then called Deaf-Mutes. His work centered on a boy named Victor. Victor had lived all of his life in the woods and mountains of southern France. He was finally caught when he was 12 years old and brought to the institute for treatment. After examination, Dr. Itard found that Victor was deaf and unable to talk.
Dr. Itard had studied the writing of John Locke and a colleague, Condillac. Their work emphasized the importance of learning through the senses. Dr. Itard developed a broad educational program for Victor to develop his senses, intellect, and emotions. Victor responded to the training and after 5 years, he still had problems with living in a community and with language, but could manage to continue to live at the institute.
Near the end of his life, Itard had the opportunity to educate a group of children who were mentally retarded. He did not personally direct the education of these children, but supervised the work of Edouard Seguin. Seguin developed a comprehensive educational program for children with mental retardation. He decided that there is a direct relationship between the senses and thought processes. His training began with sensory training including vision, hearing, taste, smell, and eye-hand coordination. The course also focused on developing basic self-care skills to vocational training that emphasized perception, coordination, imitation, positive reinforcement, memory, and generalization. In 1850, Seguin moved to the United States and was an innovator in establishing education for the mental retarded. In 1876, he founded what would become the American Association on Mental Retardation. Many of Seguin's techniques have been modified and are still in use today.
Match these terms with the definitions below:
A. mental retardation, B. John Locke, C. Sensory, intellectual, emotional training, D. 1500 B.C.
1-1. influenced training of mentally retarded.
A,
B,
C,
D.
1-2. evidence in Thebes, Egypt of mental retardation.
A,
B,
C,
D.
1-3. early program that was used to help socially retarded Victor
A,
B,
C,
D.
1-4. difficulty in learning social skills that is noted in early childhood.
A,
B,
C,
D.
In the early 1900s training schools were established for the mentally retarded. About the same time, in 1908, Binet developed the first test of intelligence. Psychologists and educators believed that with intelligence testing, mentally retarded people could be identified and given training to cure them of their disabilities. However, the curing of these people did not happen. The training schools were crowded and many of the students moved back to their own homes. Special education classes were started for the mentally retarded in regular schools.
In the 1950s and 1970s national associations for the mentally retarded were established. The Individuals With Disabilities Act was passed in 1975. It guaranteed appropriate education for all children with any type of disability from the age of 3 to 21. Another part of the law encouraged programs for infants and toddlers to help them at home before starting school. There are schools in Russia for those children who have mild retardation. I know of internats near Moscow where the children live during the week and receive special educational help to increase their abilities in all subjects. In the provinces, mentally retarded students receive no education and live in internats established for them.
Causes for Mental Retardation
Mental retardation can be caused by any condition that impairs development of the brain before birth, during birth or in the childhood years. Several hundred causes have been discovered, but in about one-third of the people affected, the cause remains unknown. The three major known causes of mental retardation are Down's syndrome, fetal alcohol syndrome and fragile X.
Genetic conditions - These result from abnormality of genes inherited from parents, errors when genes combine, or from other disorders of the genes caused during pregnancy by infections, overexposure to x-rays and other factors. More than 500 genetic diseases are associated with mental retardation. Some examples include PKU (phenylketonuria), a single gene disorder caused by a defective enzyme. Down's syndrome is an example of a chromosomal disorder. Chromosomal disorders happen sporadically and are caused by too many or too few chromosomes, or by a change in structure of a chromosome. Fragile X syndrome is a single gene disorder located on the X chromosome and is the leading inherited cause of mental retardation.
Problems during pregnancy - Use of alcohol or drugs by the pregnant mother can cause mental retardation for the baby. Recent research has implicated smoking in increasing the risk of mental retardation occurring for the child. Other risks include malnutrition, certain environmental contaminants, and illnesses of the mother during pregnancy. Illnesses that harm a fetus are toxoplasmosis, cytomegalovirus, rubella and syphilis. Pregnant women who are infected with HIV may pass the virus to their child, leading to future neurological damage.
Problems at birth - Although any unusual stress during childbirth may injure the infant's brain, prematurity and low birth weight predict serious problems more often than any other conditions.
Problems after birth - Childhood diseases such as whooping cough, chicken pox, measles, and diseases that may lead to meningitis and encephalitis can damage the brain. Accidents also cause retardation, for example, a blow to the head or asphyxia due to near-drowning. Lead, mercury and other environmental toxins can cause irreparable damage to the brain and nervous system.
Poverty and cultural deprivation - Children in poor families may become mentally retarded because of malnutrition, disease-producing conditions, inadequate medical care and environmental health hazards. Also, children in disadvantaged areas may be deprived of many common cultural and other day-to-day experiences provided to more well-off youngsters. Research suggests that such under-stimulation may result in irreversible brain damage and can be a cause of mental retardation.
Match these terms with the definitions below:
A. Prematurity and low birth weight. - B. Drugs and alcohol. - C. Chicken pox and measles. - D. Genetic conditions.
2-1. A mother's lack of control in the use of ___________ may cause mental retardation in her baby.
A,
B,
C,
D.
2-2. ____________ may cause serious mental problems at birth.
A,
B,
C,
D.
2-3. ____________ cause Down’s syndrome and Fragile X syndrome.
A,
B,
C,
D.
2-4. Some childhood diseases that may cause mental retardation are _____________.
A,
B,
C,
D.
How does Mental Retardation Affect a Person?
The effects of mental retardation vary considerably among people, just as the range of abilities varies considerably among people who do not have mental retardation. About 87 percent will be mildly affected and will be only a little slower than average in learning new information and skills. As children, their mental retardation is not readily apparent and may not be identified until they enter school. As adults, many will be able to lead independent lives in the community and will no longer be viewed as having mental retardation.
The remaining 13 percent of people with mental retardation, those with IQs under 50, will have serious limitations in functioning. However, with early intervention, a functional education and appropriate supports as an adult, many can lead satisfying lives in the community.
The Characteristics of Mental Retardation
1) Limitations in Mental Functioning
A diagnosis of mental retardation requires that an intelligence score be 70-75, that is, two standard deviations below the average intelligence score of 100. Intelligence is the capacity to learn. Individuals with mental retardation have impairments in the learning process, including attention, memory, and generalization. They are not motivated to learn because of repeated failures due to their intellectual functioning.
Attention: These people have trouble distinguishing and paying attention to relevant cues in a social situation and understanding several cues that may happen at once. For example, they may not be able to tell when a person is angry with them. They are unable to understand facial or body cues that give a clue to what another person is thinking.
Memory: They have trouble with short-term memory, that is, recalling information or directions for a few minutes or hours. This is because they cannot use strategies to remember new information. This is called "rehearsal" and includes verbally practicing the sequence of a task or associating the steps of a task with a mental picture.
Generalization: This is the ability to transfer knowledge learned from one task to another and to do so in different environments. For example, this student may know that there are 50 rubles in a 50 ruble note but at the kiosk he/she cannot understand the amount of change he/she should receive after buying a 10 ruble candy bar.
Motivation: Since they have frequent failure, these people tend to expect failure and have low goals for themselves. They also distrust their own solutions to problems and seek out cues from others to help them, therefore they have a learned helplessness.
Question:
3. How does mental retardation affect a person?
(One or more of the following answers may be correct.)
a) decreased capacity to learn.
b) low expectations of one’s own abilities.
c) Inability to buy a candy bar.
2) Adaptive Skills
A person must have limitation in 2 adaptive skill areas essential for daily functioning. They are listed in the next lecture, but here are three examples:
Self-direction: Self-direction refers to the ability of individuals to live their lives the way they choose to live them, consistent with their own values and preferences within the norms of society. Many professionals and families make decisions for the mentally retarded rather than training them to do so.
Functional Academics: These are school subjects that directly apply to and teach the skills needed in one's everyday environment. Examples are the following: learning to complete a job application, learning to use the phone book or city map, learning survival words (entrance/exit, stop, caution, men/women), learning to carry on a conversation, learning about denominations of money and making change.
Home living: These skills are those needed to live successfully within a home setting alone. For example, remember how Ryan needs to learn to control the temperature of the shower. He is also learning how to use the clothes washer at home. He needs to learn to live independently by doing the normal household tasks that everyone does.
Question:
4. Adaptive skills are defined as:
(Only one of the following answers is correct.)
a) learning to use the clothes washer.
b) skills that are needed for daily functioning at home and in society.
c) psychological constructs.