Mental Retardation: Mental Retardation: Assessment and Assessment and TreatmentTreatment

September 11, 2007September 11, 2007

Historical PerspectivesHistorical Perspectives Historically, prevailing sentiment Historically, prevailing sentiment

was one of ignorance and was one of ignorance and mistreatmentmistreatment

Degeneracy theory (1800’s) Degeneracy theory (1800’s)

The eugenics movement (early The eugenics movement (early 1900’s)1900’s)

Mental RetardationMental Retardation Significant limitations both in Significant limitations both in intellectual intellectual

functioningfunctioning and in and in adaptive behavioradaptive behavior as as expressed in conceptual, social, and expressed in conceptual, social, and practical adaptive skillspractical adaptive skills

PrevalencePrevalence– 1-3% of population1-3% of population

Slightly more males than femalesSlightly more males than females More prevalent in lower SES and in minority More prevalent in lower SES and in minority

groupsgroups– especially for mild MRespecially for mild MR– no differences for more severe levelsno differences for more severe levels

Causes of Mental Causes of Mental RetardationRetardation Majority of cases cannot be Majority of cases cannot be

explained, esp. for mild mental explained, esp. for mild mental retardationretardation

The two-group approach:The two-group approach:– organic organic

– cultural-familialcultural-familial

Diagnosing Mental Diagnosing Mental RetardationRetardation DSM-IV Criteria:DSM-IV Criteria:

– Intelligence Quotient (IQ) at or below Intelligence Quotient (IQ) at or below 7070

– Significant impairment in 2+ areas Significant impairment in 2+ areas of adaptive behaviorof adaptive behavior

– Must be evident before age 18Must be evident before age 18

IQ CriteriaIQ Criteria Four categoriesFour categories

Mild (IQ: 55-70)Mild (IQ: 55-70)

Moderate (IQ: 40-54)Moderate (IQ: 40-54)

Severe (IQ: 25-39)Severe (IQ: 25-39)

Profound (IQ: below 25 or 20)Profound (IQ: below 25 or 20)

Other CategorizationOther Categorization American Association on Mental American Association on Mental

Retardation (AAMR) categories:Retardation (AAMR) categories:– intermittentintermittent– limitedlimited– extensiveextensive– pervasivepervasive

Emphasis on interaction between Emphasis on interaction between person and environment in person and environment in determining level of functioningdetermining level of functioning

Adaptive Behavior Adaptive Behavior CriteriaCriteria Adaptive functioning: how Adaptive functioning: how

effectively an individual copes effectively an individual copes with with ordinary life demandsordinary life demands and and how capable he/she is of living how capable he/she is of living independently and abiding by independently and abiding by community standardscommunity standards

MR criteria: Impairment in two or MR criteria: Impairment in two or more areasmore areas

Vineland Adaptive Vineland Adaptive Behavior ScalesBehavior Scales Assesses adaptive behavior Assesses adaptive behavior

(birth-18 years)(birth-18 years)– Sub-domains:Sub-domains:

Communication Communication Daily Living SkillsDaily Living Skills SocializationSocialization Motor SkillsMotor Skills

– Adaptive Behavior CompositeAdaptive Behavior Composite

Age CriteriaAge Criteria Must be evident before age 18Must be evident before age 18 Why?Why?

– Developmental DisorderDevelopmental Disorder– Rule Out: Adult Degenerative Rule Out: Adult Degenerative

DiseasesDiseases

Does our patient meet Does our patient meet criteria for mental criteria for mental retardation?retardation?

Diagnostic CriteriaDiagnostic Criteria IQ at or below 70IQ at or below 70

– Intelligence testing = 68 IQIntelligence testing = 68 IQ Significant impairment in 2 or Significant impairment in 2 or

more areas of adaptive functioningmore areas of adaptive functioning– Impairments in communication, daily Impairments in communication, daily

living skills, socializationliving skills, socialization Onset before age 18Onset before age 18

– Pt is 11 years oldPt is 11 years old

Classification of Classification of PatientPatientAxis I: No diagnosisAxis I: No diagnosisAxis II: Mental Retardation (mild)Axis II: Mental Retardation (mild)Axis III: None ReportedAxis III: None ReportedAxis IV: History of child abuse, Axis IV: History of child abuse,

removed from home, foster care removed from home, foster care placementplacement

Axis V: 65 (current)Axis V: 65 (current)

Parent ReactionsParent Reactions What does this mean?What does this mean?

– Can they still go to college?Can they still go to college? Who will take care of my child Who will take care of my child

when I die? when I die? – Will they be institutionalized?Will they be institutionalized?

Concerns about stigmaConcerns about stigma– ““Don’t tell the school!”Don’t tell the school!”– Diagnosis refusal/denialDiagnosis refusal/denial

Specific concernsSpecific concerns LabelingLabeling StigmaStigma Self-fulfilling prophesySelf-fulfilling prophesy Learned helplessnessLearned helplessness

TreatmentTreatment Early intervention is Early intervention is criticalcritical

– Optimal time: Preschool yearsOptimal time: Preschool years Encourage explorationEncourage exploration Teach basic skillsTeach basic skills Celebrate achievementsCelebrate achievements Rehearsal, rehearsal, rehearsalRehearsal, rehearsal, rehearsal Protection from teasing/social Protection from teasing/social

rejectionrejection

Video: David’s StoryVideo: David’s Story

Concluding StatementsConcluding Statements Wide variability in functioningWide variability in functioning Importance of environmentImportance of environment Important to address affective Important to address affective

response to diagnosisresponse to diagnosis Do not let labels fool you!Do not let labels fool you!