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Chapter 5. Persons with Mental Retardation. 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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Chapter 5 l.jpg

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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Normal Distribution

Normal Distribution



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Theories and Tests of Intelligence

  • IQ tests

    • Intelligence quotient (IQ) tests attempt to measure an individual’s 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 Reasoning—measures reasoning with verbal material; child identifies underlying concept given successive clues.

  • Matrix Reasoning—measures fluid reasoning a (highly reliable subtest on WAIS® –III and WPPSI™–III); child is presented with a partially filled grid and asked to select the item that properly completes the matrix.

  • Picture Concepts—measures 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 Sequencing—measures working memory (adapted from WAIS–III); child is presented a mixed series of numbers and letters and repeats them numbers first (in numerical order), then letters (in alphabetical order).

  • Cancellation—measures 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 person’s 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 Scale—School

    • AAMR Adaptive Behavior Scale—Residential 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 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 1970’s

    • Normalization

    • Deinstitutionalization


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    The History of Mental Retardation VI

    • Public Education

      • First school in Providence, Rhode Island (1890’s)

      • By 1930, sixteen states offered special classes for children with mental retardation

      • By 1952, forty-six of the forty-eight states

        • Until late 1950’s children with severe and profound mental retardation were excluded from public education


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    The History of Mental Retardation VII

    • Kennedy Era (1960’s)

      • President’s 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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    Chromosomal

    Metabolic

    Nutritional

    Maternal Infections

    Fragile X, Down syndrome

    Tay-Sachs, Prader Willi syndrome

    Phenyketonuria, galactosemia

    Rubella, AIDS, syphillis, Rh factor, CMV

    Prenatal Factors


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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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    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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    Prenatal

    Postnatal

    Fetal alcohol syndrome

    Drug use

    Child abuse/neglect

    Head trauma

    Malnutrition

    Environmental deprivation

    Environmental Factors


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    Prenatal

    Postnatal

    Anencephaly

    Hydrocephaly

    Microcephaly

    Neurofribromatosis

    Tuberous sclerosis

    Compromises in Brain Function


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    Gestational disorders

    Neonatal complications

    Low birth weight

    Prematurity

    Hypoxia

    Birth trauma

    Seizures

    Respiratory distress

    Breech/prolonged delivery

    Perinatal Factors


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    Intoxicants

    Complications of childhood infections

    Lead poisoning

    Encephalitis

    Mumps, measles

    Meningitis

    Mumps, measles, chicken pox

    Postnatal Factors


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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 Students with Mental Retardation During the 1999-2000 School Year

    • 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 Students with Mental Retardation During the 1999-2000 School Year

    “ 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 Students with Mental Retardation During the 1999-2000 School Year

    • 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 Students with Mental Retardation During the 1999-2000 School Year

    • INCLUDE

    • Task analysis

    • Cooperative learning

    • Unit approach

    • Scaffolding


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    INCLUDE Students with Mental Retardation During the 1999-2000 School Year (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 Students with Mental Retardation During the 1999-2000 School Year

    • 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 Students with Mental Retardation During the 1999-2000 School Year

    • 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 Students with Mental Retardation During the 1999-2000 School Year

    • 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 Students with Mental Retardation During the 1999-2000 School Year

    • 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 Students with Mental Retardation During the 1999-2000 School Year

    • Comprehensive and collaborative plan responsive to the adolescent’s 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 Students with Mental Retardation During the 1999-2000 School Year

    • 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 Students with Mental Retardation During the 1999-2000 School Year

    • 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 Students with Mental Retardation During the 1999-2000 School Year

    • Defined in IDEA

      • Any item, piece of equipment, or product system…acquired or commercial…that 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 Students with Mental Retardation During the 1999-2000 School Year

    • 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 Students with Mental Retardation During the 1999-2000 School Year

    • 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