Mr2008
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Transcript of Mr2008
MENTAL RETARDATION
What is mental retardation?
core features:
intellectual functioning
adaptive behaviour
begins early in life
levels of functioning:
mild MR 50-55 to 70
moderate MR 35-40 to 50-55
severe MR 20-25 to 35-40
profound MR below 25
© 2006, Prentice Hall, Wicks-Nelson
Intelligence
Definition and diagnosis:
AAMR 1992MR refers to substantial limitations in present
functioning. It is characterized by significantly subaverage intellectual functioning, existing concurently with related limitations in two or more of the following applicable adaptive skill areas:
communication self-care home living social skills community use self direction health and safety functional academics leasure Work manifests before 18
DSM-IV definition:
a. significantly subaverage intellectual functioning: an IQ of approximately 70 or below
b. concurrent deficits or impairment in present adaptive functioning in at least two of the following skill areas:
communication, self-care, home living,
social interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health, and safety
c. onset is before age 18 years
provides codes for mild, moderate, severe and profound MR
Developmental course
Stability of intelligence:
in normal children:
in children with MR:
at lower levels …stability
mild MR ….. fluctuations
Stability and type of retardation:
children with Downs Syndrome:
decrease in IQ fragile x:
middle childhood or teen years
ages 10-15
Stability of adaptive behaviour:
Downs: no gains between 7 and 11 years
fragile x slowing in early teen years
intervention programs 10-15 points gains in IQ
Prevalence:adaptive functioning consideredmild MR instablemild MR and schoolingdeath of low MR
overall 2% severe levels .4%
Epidemiology
Epidemiology
sex differences:
more males than females
social class:
Low SES
severe MR
ethnic minorities
Theoretical frameworksI. Developmental approaches
ZIGLER (1969)
“familial mental retardation”
similar sequence approach
similar structure approach
matched on MA
when familial supported
Theoretical frameworks
famial MR: deficits in
memory
information processing skills
??……..motivational factors
but similar on Piagetian tasks
organic MR:
worse than MA matched
specific areas of deficit:
Downs linguistic grammar
Fragile x sequential processing
Williams Syndrome high language abilities
domains are modular
different MR different behavioural functioning
II. Families and Ecologies:
Stress and coping:
extra stressor
effects
Factors help to cope:
SES
two parent
women in better marriages
II. Families and Ecologies:
Mothers
social-emotinal support
information about child
help in child care
Fathers
financial cost
childs temperament
relationship with the child
Double ABCX model: crises of raising the child X childs characteristics A family resources B family’s perception of the child C
mothers may have many reactions
© 2006, Prentice Hall, Wicks-Nelson
Etiology
Cause not known in 30-40% of clinic cases Cause harder to determine in mild cases Organic versus Cultural-familial (table 11-6) Organic (Table 11-7)
Prenatal Perinatal Postnatal
Genetic Syndromes Table 11-8 Down Syndrome
Most common single disorder
Caused by Trisomy 21 Higher risk with
maternal age Alzheimer’s Moderate to severe MR Delayed speech, verbal
short term memory and auditory processing deficits
Genetic Syndromes Fragile X
Most common inherited form
Fractured X chromosome More common in boys-
they have more severe forms
Long faces, prominent jaws, large ears (males)
Visual-spatial, sequential processing, motor coordination and executive function deficits
Social impairments
© 2006, Prentice Hall, Wicks-Nelson
Genetic Syndromes
Williams SyndromeRareDeletions on Chromosome 7Mild to moderate MRGeneral knowledge & visual spatial deficitsRelative strengths in language Elfin appearance
© 2006, Prentice Hall, Wicks-Nelson
Multifactor Causation
Current theories posit a complicated interaction between biology and environment (Table 11-9)
ETIOLOGIES
“two group approach”
organic familial
social functionmarked imp. Minor to none
cause majority organic minority org.
family history normal low IQ
organic familial
background equal SES low SES
appearance dysmorphic normal
medical comp. Low fertility normal
physical hand.
Short life expect.
Psychiatric comp. Severe disord. similar dis.
Autism to normal but
Self injury more freq.
Hyperactivity
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Behavioral Problems and Co-occurring Diagnoses
These include: Depression Attention Problems and Hyperactivity Aggression Obsessive-compulsive behavior Schizophrenia Autism Stereotyped behavior Self Injurious Behavior