Persons with Mental Retardation

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Chapter 5

• Persons with Mental Retardation

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AAMR Definitions

• Since 1876 the American Association on Mental
  Retardation has revised its definition of mental
  retardation eleven times
• Revisions reflected change
• Terminology
• Classification
• Expectations

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AAMR Significantly Subaverage Intellectual
Functioning
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Normal Distribution
Normal Distribution
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Bell Curve
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Theories and Tests of Intelligence

• IQ tests
• Intelligence quotient (IQ) tests attempt to
  measure an individuals probable performance in
  school and similar settings.

Binet (1857-1911) and Simon created 1st IQ ?
test in 1905
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Theories and Tests of Intelligence

• The Stanford-Binet test
• The Stanford-Binet test - V (2-85)
• The mean or average IQ score for all age groups
  is designated as 100 15 (85-115).
• Given individually

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Individual Intelligence TestsThe Wechsler Scales

• Overall IQ and also verbal and performance IQs.
• (WPPSI-III) Wechsler Preschool and Primary Scale
  of Intelligence-Revised. Ages 2 ½ to 7 years, 3
  months
• (WISC-IV) Wechsler Intelligence Scale for
  Children-Revised. Ages 6 to 16 years, 11 months
• (WAIS-III) Wechsler Adult Intelligence
  Scale-Revised
• Ages 16-89

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WPPSI
WPPSI-III
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WISC-IV

• Word Reasoningmeasures reasoning with verbal
  material child identifies underlying concept
  given successive clues.
• Matrix Reasoningmeasures fluid reasoning a
  (highly reliable subtest on WAIS III and
  WPPSIIII) child is presented with a partially
  filled grid and asked to select the item that
  properly completes the matrix.
• Picture Conceptsmeasures fluid reasoning,
  perceptual organization, and categorization
  (requires categorical reasoning without a verbal
  response) from each of two or three rows of
  objects, child selects objects that go together
  based on an underlying concept.
• Letter-Number Sequencingmeasures working memory
  (adapted from WAISIII) child is presented a
  mixed series of numbers and letters and repeats
  them numbers first (in numerical order), then
  letters (in alphabetical order).
• Cancellationmeasures processing speed using
  random and structured animal target forms (foils
  are common non-animal objects).

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Pitfalls of IQ Testing

• There is a potential for cultural bias because of
  the highly verbal nature of the test and the
  reflection of middle-class Anglo standards
• IQ is not static but capable of changing
• Overemphasis on IQ scores as the sole indicator
  of a persons worth reduces the value of other
  factors such as adaptive skills

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1992 AAMR Definition

• Significantly subaverage intellectual ability
• Exists concurrently with limitations in two or
  more adaptive skill areas
• Manifests before age 18
• Adaptive skill areas communication, self-care,
  home living, social skills, community use, self
  direction, health and safety, functional
  academics, leisure, and work

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2002 AAMR Definition

• Characterized by signification limitations both
  in intellectual functioning and in adaptive
  behavior
• Adaptive behavior expressed in conceptual,
  social, and practical adaptive skill
• Disability originates before age 18

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Five Assumptions of the 2002 AAMR Definition

• Limitations occur within the community
  environment consider age, peers, and culture
• Limitations often coexist with strengths
• Limitation identification profiles need supports
• Valid assessment considers differences in
  culture, language, as well as communication,
  sensory, motor, and behavioral factors
• With appropriate personalized supports, the life
  functioning of an individual with mental
  retardation will generally improve

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Adaptive Behavior

• Measured by test instruments
• AAMR Adaptive Behavior ScaleSchool
• AAMR Adaptive Behavior ScaleResidential and
  Community
• Vineland Social Maturity Scale
• Assess areas of personal responsibility, daily
  living skills, social adaptations, and
  maladaptive behavior as they occur within the
  demands of everyday life

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Classification Schemas

• Etiological Perspective
• Established by medical or biological causes
• Intellectual Deficit
• Determined by IQ testing
• Educational Perspective
• Based on anticipated educational accomplishments,
  educable or trainable
• Levels of Support
• Intermittent, limited, extensive, or pervasive
  natural or formal

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The Dynamics of Intelligence
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The History of Mental Retardation I

• The Greek Empires
• Sparta valued physical strength and intellectual
  ability infanticide, eugenics
• Athens unwanted newborns placed into a jar at
  the temple doors eventually sold as slaves
• The Roman Republic
• During first 8 days of life infants were allowed
  to perish Columana Lactaria mutilated to
  heighten their value as future beggars

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The History of Mental Retardation II

• Middle Ages- a time of contrasts
• Les Enfants du Bon Dieu valued as agrarian
  workers treasured as court jesters
• King Henry II of England declared natural fools
  wards of the king
• Superstition, witchcraft, demonic possession,
  imprisoned as a danger to society
• Renaissance embraces humanism

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The History of Mental Retardation III

• Early Optimism
• Esquirol (1782-1840) Amentia (without mind)
• Imbeciles- mild mental retardation
• Idiots- severe, profound mental retardation
• Itard (1774-1838) Victor the wild man
• Father of Special Education- individuals with
  mental retardation are capable of learning

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The History of Mental Retardation IV

• Early Optimism (continued)
• Seguin (1812-1880) Paris school promoted
  physiological and moral education
• Founded Association of Medical Officers of
  American Institutions for the Feeble-minded
  Persons, the forerunner to the AAMR
• Howe (1801-1876) First residential school
  promoted reintegration and rehabilitation

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The History of Mental Retardation V

• Protection and Pessimism (1860-1960)
• 1927 US Supreme Court (Buck v. Bell) upheld
  sterilization of genetic misfits
• Institutions become permanent residences often
  with deplorable living conditions
• Christmas in Purgatory by Blatt and Kaplan (1966)
• The 1970s
• Normalization
• Deinstitutionalization

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The History of Mental Retardation VI

• Public Education
• First school in Providence, Rhode Island (1890s)
• By 1930, sixteen states offered special classes
  for children with mental retardation
• By 1952, forty-six of the forty-eight states
• Until late 1950s children with severe and
  profound mental retardation were excluded from
  public education

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The History of Mental Retardation VII

• Kennedy Era (1960s)
• Presidents Panel on Mental Retardation
• Introduced an era of national concern for the
  rights of individuals
• Eventual increase in federal aid to education
• Establishment of comprehensive community- based
  program
• Educational rights
• Movement toward less restrictive and more
  integrated educational placements

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Prevalence (US Department of Education, 2002)

• Students classified as mentally retarded
• Represent 11 of all pupils with a disability
• 1 of student population
• 612,978 individuals
• Has decreased 37 since 1975
• Changes in definition
• Impact of legislation
• Reluctance to identify children in minority
  groups as mentally retarded

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Etiology of Mental Retardation

• Prenatal occurring before birth
• Perinatal occurring around the time of birth
• Postnatal occurring after birth

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Prenatal Factors

• Chromosomal
• Metabolic
• Nutritional
• Maternal Infections

• Fragile X, Down syndrome
• Tay-Sachs, Prader Willi syndrome
• Phenyketonuria, galactosemia
• Rubella, AIDS, syphillis, Rh factor, CMV

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FRAGILE X SYNDROME

• eye vision impairments Hyper-extensible joints
  (double jointed)
• elongated face Large testicles (evident after
  puberty)
• Flat feet Low muscle tone
• High arched palate Autism and autistic-like
  behavior
• Prominent ears hand biting and hand-flapping
• Mental Retardation Hyperactivity and short
  attention span

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Trisomy 21
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TURNER SYNDROME (ONLY AN X CHROMOSOME)

• short stature and lack of ovarian development,
  webbed neck, arms that turn out slightly at the
  elbow, and a low hairline in the back of the head
  are sometimes seen in Turner syndrome patients

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Down Syndrome (Trisomy 21)

• Physical Deformities

flattening of the back of the head slanting of
the eyelids short stubby limbs thick tongues)
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Environmental Factors

• Prenatal
• Postnatal

• Fetal alcohol syndrome
• Drug use
• Child abuse/neglect
• Head trauma
• Malnutrition
• Environmental deprivation

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Compromises in Brain Function

• Prenatal
• Postnatal

• Anencephaly
• Hydrocephaly
• Microcephaly
• Neurofribromatosis
• Tuberous sclerosis

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Perinatal Factors

• Gestational disorders
• Neonatal complications

• Low birth weight
• Prematurity
• Hypoxia
• Birth trauma
• Seizures
• Respiratory distress
• Breech/prolonged delivery

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Postnatal Factors

• Intoxicants
• Complications of childhood infections

• Lead poisoning
• Encephalitis
• Mumps, measles
• Meningitis
• Mumps, measles, chicken pox

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Prevention of Mental Retardation

• Primary Prevention
• Amniocentesis, chorionic villus sampling,
  utlrasound, prenatal screening
• Secondary Prevention
• PKU and galactosemia screening following birth,
  shunts for hydrocephalus
• Tertiary Prevention
• Early intervention, community based services

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Services for Young Children with Mental
Retardation

• Early intervention (birth to 5)
• Family services and support rendered to children
  with disabilities or children who evidence risk
  factors
• Established risk
• Environmentally at risk
• Aims to positively effect social, emotional,
  physical, and intellectual well being

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Goals of Early Intervention

• Consortium of services working together to
  minimize and if possible reverse the impact of
  delay or deficits in normal cognitive development
  on later school performance
• Health care
• Social services
• Educational assistance
• Family centered support

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Areas that Influence Learning

• Attention
• Memory
• Academic performance
• Motivation
• Language development

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Social and Behavioral Characteristics

• May exhibit poor interpersonal skills
• May have difficulty in choosing the appropriate
  social interaction
• Frequently encounter rejection by classmates and
  peers
• Have difficulty maintaining friendships

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Figure 5.5 Figure Represents Percentage of
Enrollment of Students with Mental Retardation
During the 1999-2000 School Year
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Educational Programming

• Functional curriculum
• Life skills
• Academic skills applied to everyday, practical
  life situations (making change, following
  directions)
• Functional academics
• Personal hygiene, independent living skills,
  community resources
• Community Based Instruction

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Points to Ponder

• Although a functional curriculum is seen as
  appropriate for many individuals with mental
  retardation, in many ways it runs counter to the
  basic tenets of the philosophy of full inclusion
  with its emphasis on age-grade- appropriate
  placement. (Garguilo)

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Instructional Methodology

• Instructional methodologies and accommodations
  that are used with pupils who are mentally
  retarded are the same ones that make learning
  successful for all students (Friend Bursuck,
  2002)
• Reasonable accommodation for students with
  special needs is within the capability of the
  general educator

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Instructional Methodology

• INCLUDE
• Task analysis
• Cooperative learning
• Unit approach
• Scaffolding

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INCLUDE (Friend Bursuck, 2002)

• Identify classroom environment, curricular, and
  instructional demands
• Note student learning strengths and needs
• Check for potential areas of student success
• Look for potential problem areas
• Use information gathered to brainstorm
  instructional adaptations
• Decide which adaptations to implement
• Evaluate student progress

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Task Analysis

• Breaking of a complex task or behavior into its
  component parts
• Select goals
• Identify prerequisite skills and materials needed
  to perform the task
• Identify specific components of the task and
  sequence component parts
• Evaluate instruction and task mastery level
• Seek to generalize skill to other settings

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Cooperative Learning

• Teacher structured activity
• Small, heterogeneous groups
• Active involvement in accomplishing goal
• Individuals contribute according to ability
• Pupils with disabilities may require special
  preparation for maximum participation
• Recognition and rewards based on group
  performance
• Individual success contributes to the whole

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Unit Approach

• Individual units designed to teach daily living
  skills are taught within the content areas
• Language arts
• Reading
• Mathematics
• Goals are adjusted for chronological age and
  developmental levels

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Scaffolding

• Introduce concept
• Present concept one step at a time using
  simplified situations and guided practice
• Vary contexts for student practice
• Employ constructive feedback and opportunity for
  self-evaluation
• Increase student responsibility to use the
  strategies independently
• Provide extensive opportunity for practice

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Transition into Adulthood

• Comprehensive and collaborative plan responsive
  to the adolescents goals and visions for
  adulthood
• Educators
• School personnel
• Adult service providers
• Family members
• Transition services are part of PL 101-476 and
  must be in place no later than age 16

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Supported Competitive Employment

• Cost effective
• Mutually beneficial to employee with a disability
  and employer
• Job coaching enables adolescent to learn specific
  job requirements on site
• Coaches match needs of employer to abilities of
  the student worker
• Found to be more successful to promote
  competitive employment skills than the sheltered
  workshop model

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Adults with Mental Retardation

• Normalization
• Maximizing personal control of life within the
  norms and patterns of mainstream society
• Self-determination
• Independent decision making
• Self-advocacy
• Assertively stating want, needs, and desires

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Assistive Technology

• Defined in IDEA
• Any item, piece of equipment, or product
  systemacquired or commercialthat is used to
  increase, maintain, or improve functional
  capabilities
• Compensates for the functional limitation of an
  individual and helps the person function in a
  natural environment

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Areas for Technology

• Activities of daily living
• Hygiene, meal preparation, e-mail
• Employment
• Computer skills, mobility, correspondence
• Sports and recreation
• Participation in activity, access to events
• Communication
• Written and verbal interactions, voice

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Trends, Issues, and Controversies

• Increase in community-based activities
• Increasing need for assistive technology
• Assessment of quality of life and normalization
• Existence of a growing geriatric population
• Increase in inclusive educational placements
• Fostering of self-advocacy and self-
  determination
• Ethical issues and hopes for biomedical research