Lecture # 103:
Mental Retardation, Continued

copyright 2008 Cheryl K. Hosken, BSN, MS Psych.

Objectives:

  1. The student will understand the process of diagnosing mental retardation.
  2. The student will learn the types of schooling given to the mentally retarded.

How is Mental Retardation Diagnosed?
The AAMR process for diagnosing and classifying a person as having mental retardation contains two steps and a system of supports a person needs to overcome limits in adaptive skills.

The first step in diagnosis is to have a qualified person give one or more standardized intelligence tests and a standardized adaptive skills test, on an individual basis. The person with mental retardation has an intellectual function of 70-75% or below. He has significant disabilities in two or more adaptive skill areas.

What are adaptive skills? They are those areas of daily living skills needed to live, work and play in the community. They include communication, self-care, home living, social skills, leisure, health and safety, self-direction, functional academics (reading, writing, basic math), community use and work.

Adaptive skills are assessed in the person's typical environment across all aspects of an individual's life. A person with limits in intellectual functioning who does not have limits in adaptive skill areas may not be diagnosed as having mental retardation.

Meditate Word By Word On These Verses:
Luke 9:37-42 and Mark 7:31-37

Adaptive Skills are listed below:

  1. Independent Functioning
    A. Eating
    B. Toilet Use
    C. Cleanliness
    D. Appearance
    E. Care of Clothing
    F. Dressing and undressing
    G. Travel
  2. Physical Development
    A. Sensory Development -use of 5 senses
    B. Motor Development
  3. Economic Activity
    A. Money Handling and Budgeting
    B. Shopping Skills
  4. Language Development - the ability to comprehend and express information through symbols (spoken and written words) and non-symbolic behaviors (facial expressions, touch, gestures, body movements)
    A. Expression of thoughts
    B. Verbal Comprehension - understanding what is said to him
    C. Social Language Development - learning to converse with others
  5. Numbers and Time
  6. Prevocational and Vocational Activity - skills needed to have a job full or part-time and work behaviors
  7. Self-Direction: skills related to making choices about behavior
    A. Initiative
    B. Perseverance
    C. Leisure Time
  8. Responsibility
  9. Social Skills
  10. Social Behavior
  11. Conformity to Social Norms
  12. Trustworthiness
  13. Stereotypical (inappropriate or repetitive acts) and Hyperactive Behavior
  14. Self-Abusive Behavior
  15. Social Engagement (ability to be with others and carry on conversations)
  16. Disturbing Interpersonal Interactions

Question:
1. Learning adaptive skills is important because:

 

 

Each of these adaptive skill areas has subscales to determine the child's abilities. For example, the social skills subscale has the following parameters:

The second step is to describe the person's strengths and weaknesses across the following four dimensions:

  1. Intellectual and adaptive behavior skills means that his intelligence is significantly below normal and his ability to do certain tasks according to his age group is deficit. For example a first class child should be able to dress himself, but a mentally retarded child may not be able to fully dress himself.
  2. Psychological/emotional considerations means that he has behavior problems (lack of attention, he may have self-abusive behavior such as hitting or pinching himself) and may also have psychological problems.
  3. Physical health/etiological considerations identify the quality of his physical health and whether there are treatments or assistive devices that need to be given to the child. Perhaps he needs glasses to help him read, or a hearing aid to communicate better with others.
  4. Environmental consideration identifies his current environment and an optimal environment that would help the child grow and develop. For example, if he lives in a children's home, he may not get the individual attention he needs. Perhaps the best environment for him is with a family or a relative.

After diagnosis, the next phase is assessment, which requires an interdisciplinary team to determine the teaching or support needed for the four dimensions above. Support refers to the amount of help a person will need to live life in society. Each support identified is assigned one of four levels of intensity - intermittent, limited, extensive, and pervasive.

Intermittent support refers to support on an "as needed basis." An example would be support that is needed in order for a person to find a new job in the event of a job loss. An individual may need intermittent support occasionally over his/her lifespan, but not on a continuous daily basis.

Limited support may occur over a limited time span such as during transition from school to work or in time-limited job training. This type of support has a limit on the time that is needed to provide appropriate support for an individual.

Extensive support in a life area is assistance that an individual needs on a daily basis that is not limited by time. This may involve support in the home and/or support in work. Intermittent, limited and extensive supports may not be needed in all life areas for an individual.

Pervasive support refers to constant support across environments and life areas and may include life-sustaining measures. A person requiring pervasive support will need assistance on a daily basis across all life areas.

Therefore, the three steps to evaluate a person for mental retardation are:

  1. give standardized examinations for intelligence and adaptive skills,
  2. find and describe the person's weaknesses,
  3. identify the level of support needed for intellectual, psychological, physical, and environmental parts of his life.

This type of assessment long and difficult to do, but with knowledge of the mentally retarded person, a plan can be made so that he can live in the community in the most normal way possible.

Question:
2. Define the four levels of support that mentally retarded people need:

 

 

For infants and small children with mental retardation, it is most important to begin working with them as soon as possible. When a mentally retarded baby is identified, families need assistance and education about the child. Usually, these children are identified through failure of normal developmental abilities and behavior. If they are born with a high risk of having mental or physical problems, there needs to be a cell study to confirm a diagnosis.

The cell study can identify if an extra chromosome is present, as happens with Down's Syndrome children. Children with Down's Syndrome are especially prone to heart abnormalities, strabismus of one of the eyes, hearing deficits, and thyroid insufficiency. Because of the fragility of their health, they are also prone to infections and need immunizations against varieties of flu. Therefore, periodical medical exams are necessary for further diagnosis and treatment.

As Down's Syndrome children grow, growth and development standards are used to compare the DS child to a normal child. From the comparison, we can know the delays of the DS child and use various physical and occupational therapies to assist his progress developmentally. From 1-5 years, the child needs regular orthopedic examinations to identify skeletal problems - especially in the hips, knees, and feet. Sometimes there is a tendency to scoliosis.

It is important for the person working with mentally retarded children to know the normal growth and development of a child. These children will be slower in physical growth and development. For example, such a child may not walk until he is two years old. Helping him with physical activities that promote balance and strength will help him even if he is slower than the normal population.

They can also be tested for their intelligence at an early age, from six months onward. The results of this testing give the professional teachers, physical therapists, occupational therapists, and social workers the information they need to make a plan to work with the child. The child needs such experiences as sensory stimulation, exercise programs for physical development of muscles, and mental stimulation.

Question:
3. Why do small children with mental retardation need to be identified when they are very young?
(Select the best answer.)
a) to understand them better as they grow.
b) to help them get the medical care they need.
c) to use therapies to help them develop as normally as possible.

 

 

How Are Mentally Retarded Children Taught in Schools?
There are three curriculum options offered for students with mild to moderate mental retardation. They are general classroom support, remedial, and adult living.

General classroom support helps students in the regular classroom to succeed with the set curriculum of education. Each class has a teacher's aid who gives these children tutorial help, alternatives to learning, and helping them to understand the education goals for the various subjects.

Remedial classes usually are in a separate classroom with a separate curriculum. These students cannot follow the general education curriculum because of their decreased ability to learn as a normal student would learn. They are taught basic academic subjects - reading, writing, math intensively so they learn as much as possible. They also learn social skills - how to meet others, conversation skills, acceptable behaviors on transport and in places such as theaters, sports events, school activities.

Adult living and life skills preparation is the third option. This option is for those children who need the most support because of their limited intelligence. Most of these students will not be able to succeed in high school, get a job, or live independently. The life skills program identifies the environments where the student will live - home, neighborhood (for shopping by themselves, recreation, and friendships), school. Then the students are taught how to use transportation, do general housework to keep their home clean, learn directions to various places in their neighborhood, shopping for food, how to spend leisure time or have a hobby, and learn their own personal likes and dislikes.

Question:
4. Much time is spent on rehabilitation of the mentally retarded because their needs are great. What attitude do you have regarding this?
(Select the best answer.)
a) it costs a lot of money and takes time, therefore it is best to not do anything.
b) we should try to help them live better lives.
c) we need more help in understanding and working with these children.

 

 

Mentally retarded students learn best when there is a daily plan for their instruction and a goal that they can understand. This means a goal expressed in a short sentence is used for each activity of the day. Positive reinforcement encourages these children to repeat behavior that will help them later in life. Since mentally retarded students require intensive instruction and training to overcome the skill deficits they have, they are usually taught in a special classroom with a teacher whose specialty is teaching the mentally retarded. Since most of these students cannot manage to complete a regular secondary education program, they need to be taught separately.

In the secondary schools, there are school-to-work programs that help mentally retarded students learn a job. The businessmen of a community offer jobs to such students. The schools and the businessmen work together to identify the students' skills, training, and choices to match the students to the jobs available. The school provides a job coach or trainer to help the student learn the job and be successful at it. Often such jobs are those that would be boring for a normal person, but give the mentally retarded person a challenge. Such jobs are delivering mail in big offices, cleaning floors, counting and packaging small parts, applying labels to boxes, operating a copy machine, and stocking shelves in stores. If the student does well, a permanent job awaits him when he finishes his secondary schooling.

Question:
5. Why is teaching normal behavior strategies important for the mentally retarded person?
(Select the best answer.)
a) he knows when to cross the street with the lights.
b) his behavior is then more acceptable and he is not so strange.
c) his parents need him to know what is acceptable.

 

 

Family Intervention to Prevent Social Mental Retardation
Programs for families can help prevent mental retardation of children from low-income families. All families have strengths and weaknesses, but their basic needs (food, shelter and clothing) need to be met before the parents can concentrate on the goals of parenting their children, education, and employment. In such programs each family has a support person who helps the parents to identify the needs, establish goals, and meet with community organizations that can help them with housing, food, and employment. The support person visits the family every week to find out if goals are being met.

If goals are not met, the support person and the parents analyze why not and make new plans. Community organizations that can help such parents are schools, hospitals, child-care agencies, transportation, and adult education programs. To prevent mental retardation, mothers and their support person work together to make sure that the mother has good nutrition and health. The projects have reported that baby's birth weights have been normal and premature babies are rare.

Here is an example of a family needing a support program. Joan was 23-year-old mother of three boys under the age of 5 years. Her husband had left her. She did not have a high school diploma and lived on money from the government. Each of her three sons has special mental needs. The eldest son, James, had behavior problems at schools and at home. Her second son, Roger, has delayed speech. The youngest, Ben, who was three months, would not eat well and was hospitalized for malnutrition.

Joan's life was consumed by the needs of her three sons, and she did not have the education to help her cope with all of the appointments they had with several health agencies. Finally, she was so overwhelmed that she lost confidence in her ability to care for them and gave custody of her children to her mother.

The support program contacted Joan since she needed help with her life. Over a 2-month period, she met with the support person, Linda, and a bond of trust between them grew. Linda helped to coordinate the services of the organizations helping Joan. They were transportation to and from appointments, the local government welfare office, early childhood teachers, the university hospital, the nutritionist from the city welfare office, the landlord, and the developmental psychologist. Linda coordinated a meeting with all of these people to help solve Joan's problems and set goals for support of the family. Instead of being confused about all the agencies and the appointments she needed to make, Joan began to feel that she had some understanding and support for her family.

Linda and the support program have been part of Joan's life now for 2 years. She again has her own children at home. It was discovered that James had a hearing loss. He was provided with hearing aids, and now talks constantly to his family.

Ben is a busy, growing three-year-old. Roger is in a pre-school for children with behavior problems and he is gradually learning how to interact with other people. Joan now has more time for herself and her family. Linda helps Joan with parenting skills. Joan tries to help each of her sons according to their stages of physical and emotional development. She is able to take classes during the day when the children are in child-care.

Joan hopes to get her high school diploma soon. Then she will have some training in a vocational program for computer operators so that she has a skill for a job she wants. This family, although not perfect, will not suffer from mental deprivation. The mother has learned new skills and has hope for the future. It has taken much time, but the effort will help three boys live a more healthy, normal life.

Question:
6. Support programs for families that prevent deprivation and retardation:
(One or more of the following answers may be correct.)
a) require time and teaching for the parents.
b) makes parents dependent on a social worker.
c) is a team effort with various professionals helping the parents.

 

 

Prevention of Mental Retardation
This prevention has three elements: primary, secondary, and tertiary.

Primary prevention refers to making changes before mental retardation occurs. Examples include vaccines for the prevention of diseases that cause mental retardation. The most important vaccine is against rubella measles. Another example is educational programs for pregnant women that educate about the abuse of drugs during pregnancy and its effect on a baby.

Secondary prevention refers to intervention soon after the detection of a medical or psychosocial problem. Examples of these are screening for lead poisoning from paint, medical control of seizure disorders that may impair the brain, and early intervention programs for children who are diagnosed with mental retardation.

Tertiary prevention refers to special educational programs, physical and occupational training to reduce the effects of mental retardation.

The causes that lead to mental retardation include: lack of prenatal care, low birth weight, adolescent pregnancies, poor nutrition, exposure to toxic substances, sexually transmitted diseases, child abuse and neglect.

A Dream for the Future
Four years later: Ryan Banning is now working at firehouse #5. He is responsible for all of the yard work around the firehouse. He knows that his work has value because the area is clean and beautiful. The firefighters also treat him as a co-worker.

His workday follows a pattern. He works from 8:30 A.M. to 5:00 P.M. He mows the yard around the firehouse, rakes the leaves, shovels snow in the winter, and guards the area. In the afternoons, he helps the firefighters to clean and polish the fire trucks and replace supplies in the truck.

Once each week, a community worker comes to his house to meet Ryan and his wife. They decide on menus for the coming week and go shopping to buy the food they need. They then prepare the meals and freeze them so that meal preparation time is minimal during the week. They are saving money to buy an apartment.

During their free time, they go to movies or take bowling lessons. A few times a month they are volunteers through a church-sponsored program. They go to a local nursing home where they help the old people with recreational activities. Ryan's life is productive and satisfying to him.