Mental Retardation: Assessment and Intervention

Mental Retardation: Assessment and Intervention

Mental Retardation: Assessment and Treatment September 11, 2007 Historical Perspectives Historically, prevailing sentiment was one of ignorance and

mistreatment Degeneracy theory (1800s) The eugenics movement (early 1900s)

Mental Retardation Significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills

Prevalence 1-3% of population Slightly more males than females More prevalent in lower SES and in minority groups especially for mild MR

no differences for more severe levels Causes of Mental Retardation Majority of cases cannot be explained, esp. for mild mental

retardation The two-group approach: organic cultural-familial Diagnosing Mental Retardation DSM-IV Criteria:

Intelligence Quotient (IQ) at or below 70 Significant impairment in 2+ areas of adaptive behavior Must be evident before age 18 IQ Criteria Four categories

Mild (IQ: 55-70) Moderate (IQ: 40-54)

Severe (IQ: 25-39) Profound (IQ: below 25 or 20) Other Categorization American Association on Mental

Retardation (AAMR) categories: intermittent limited

extensive pervasive Emphasis on interaction between person and environment in determining level of functioning Adaptive Behavior Criteria

Adaptive functioning: how effectively an individual copes with ordinary life demands and how capable he/she is of living independently and abiding by community standards MR criteria: Impairment in two or

more areas Vineland Adaptive Behavior Scales Assesses adaptive behavior (birth-18 years) Sub-domains: Communication

Daily Living Skills Socialization Motor Skills Adaptive Behavior Composite Age Criteria

Must be evident before age 18 Why? Developmental Disorder Rule Out: Adult Degenerative Diseases Does our patient meet criteria for mental retardation?

Diagnostic Criteria IQ at or below 70 Intelligence testing = 68 IQ Significant impairment in 2 or

more areas of adaptive functioning Impairments in communication, daily living skills, socialization Onset before age 18 Pt is 11 years old Classification of

Patient Axis I: No diagnosis Axis II: Mental Retardation (mild) Axis III: None Reported Axis IV: History of child abuse, removed from home, foster care placement Axis V: 65 (current) Parent Reactions

What does this mean? Can they still go to college? Who will take care of my child when I die? Will they be institutionalized?

Concerns about stigma Dont tell the school! Diagnosis refusal/denial Specific concerns

Labeling Stigma Self-fulfilling prophesy Learned helplessness Treatment

Early intervention is critical Optimal time: Preschool years

Encourage exploration Teach basic skills Celebrate achievements Rehearsal, rehearsal, rehearsal Protection from teasing/social rejection Video: Davids Story Concluding Statements

Wide variability in functioning Importance of environment Important to address affective response to diagnosis

Do not let labels fool you!

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