Mental Retardation: Assessment and Treatment September 11, 2007

Historical Perspectives Historically, prevailing sentiment was one of ignorance and mistreatment Historically, prevailing sentiment was one of ignorance and mistreatment Degeneracy theory (1800’s) Degeneracy theory (1800’s) The eugenics movement (early 1900’s) The eugenics movement (early 1900’s)

Mental Retardation Significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills Significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills Prevalence Prevalence –1-3% of population Slightly more males than females Slightly more males than females More prevalent in lower SES and in minority groups 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 Majority of cases cannot be explained, esp. for mild mental retardation The two-group approach: The two-group approach: –organic –cultural-familial

Diagnosing Mental Retardation DSM-IV Criteria: 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 Four 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 Categorization American Association on Mental Retardation (AAMR) categories: American Association on Mental Retardation (AAMR) categories: –intermittent –limited –extensive –pervasive Emphasis on interaction between person and environment in determining level of functioning 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 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 MR criteria: Impairment in two or more areas

Vineland Adaptive Behavior Scales Assesses adaptive behavior (birth-18 years) Assesses adaptive behavior (birth-18 years) –Sub-domains: Communication Communication Daily Living Skills Daily Living Skills Socialization Socialization Motor Skills Motor Skills –Adaptive Behavior Composite

Age Criteria Must be evident before age 18 Must be evident before age 18 Why? Why? –Developmental Disorder –Rule Out: Adult Degenerative Diseases

Does our patient meet criteria for mental retardation?

Diagnostic Criteria IQ at or below 70 IQ at or below 70 –Intelligence testing = 68 IQ Significant impairment in 2 or more areas of adaptive functioning Significant impairment in 2 or more areas of adaptive functioning –Impairments in communication, daily living skills, socialization Onset before age 18 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? What does this mean? –Can they still go to college? Who will take care of my child when I die? Who will take care of my child when I die? –Will they be institutionalized? Concerns about stigma Concerns about stigma –“Don’t tell the school!” –Diagnosis refusal/denial

Specific concerns Labeling Labeling Stigma Stigma Self-fulfilling prophesy Self-fulfilling prophesy Learned helplessness Learned helplessness

Treatment Early intervention is critical Early intervention is critical –Optimal time: Preschool years Encourage exploration Encourage exploration Teach basic skills Teach basic skills Celebrate achievements Celebrate achievements Rehearsal, rehearsal, rehearsal Rehearsal, rehearsal, rehearsal Protection from teasing/social rejection Protection from teasing/social rejection

Video: David’s Story

Concluding Statements Wide variability in functioning Wide variability in functioning Importance of environment Importance of environment Important to address affective response to diagnosis Important to address affective response to diagnosis Do not let labels fool you! Do not let labels fool you!