1. MENTAL RETARDATION
DR SEDDIGH

3. Pre test Custodial MR ???? Severe MR ???? %
Sex >>>>>> ????
Peer bahavior ????
Intellectual disability ????

4. HISTORY
Mental retardation recognized perhaps longer than any other currently studied in psychology
Written documents from ancient Egypt made oblique reference to the condition as early as about 1500 BC
was often viewed as part of mental illness
relatively common

5. Historical Treatment of MR
Egypt 1500 B.C.
Ancient Greece
200 A.D. Rome
Middle Ages
Reformation

6. Features of Mental Retardation
DSM-IV Criteria
significantly subaverage IQ (<70)
concurrent deficits or impairments in adaptive functioning
characteristics evident prior to age 18

7. Mental Retardation
defined in the Diagnostic and Statistical Manual of Mental Disorders-IV as:
significantly subaverage intellectual functioning: an IQ of approximately 70 or below
concurrent deficits or impairments in present adaptive functioning in at least two of the following areas:communication, self-care, home living, social/interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health, and safety; and
onset before age 18 years.   

9. Describing and Classifying Mental Retardation
5 DSM-IV-TR severity classifications for mental retardation

10. Mild – IQ of 50-55 to about 70 (Educable)
Moderate – IQ of to (Trainable)
Severe – IQ of to (Custodial)
Profound – IQ below 20 or 25 (Custodial)
Unspecified – presumption of mental retardation but intelligence not testable with standardized instruments

11. Mild Retardation
Some 85% of all people with mental retardation fall into the category of mild retardation (IQ 50–70)
They are sometimes called “educably retarded” because they can benefit from schooling
typically not identified until elementary school years
People with mild retardation typically need assistance but can work in unskilled or semiskilled jobs
Intellectual performance seems to improve with age

13. Mild Retardation
Research has linked mild mental retardation mainly to sociocultural and psychological causes, particularly:
Poor and unstimulating environments
Inadequate parent-child interactions
Insufficient early learning experiences

14. Mild Retardation
Although these factors seem to be the leading causes of mild mental retardation, at least some biological factors may also be operating
Studies have linked mothers’ moderate drinking, drug use, or malnutrition during pregnancy to cases of mild retardation

16. Moderate, Severe, and Profound Retardation
Approximately 10% of persons with mental retardation function at a level of moderate retardation (IQ 35–49)
They can care for themselves and benefit from vocational training
About 4% of persons with mental retardation display severe retardation (IQ 20–34)
They usually require careful supervision and can perform only basic work tasks

17. Moderate, Severe, and Profound Retardation
About 1% of persons with mental retardation fall into the category of profound retardation (IQ below 20)
With training they may learn or improve basic skills but they need a very structured environment
Severe and profound levels of mental retardation often appear as part of larger syndromes that include severe physical handicaps

18. Prevalence 1-3% of population (depending on cutoff)
Slightly more males than females
More prevalent in lower SES and in minority groups, especially for mild MR; no differences for more severe levels

20. Developmental Course
Often children with mental retardation experience helplessness and frustration in their learning environments, which leads to low expectations and limited success
With appropriate training and opportunities, children who have mild mental retardation may develop good adaptive skills in other domains

21. Language and Social Development
Expressive language development may be weak in children with Down syndrome
Fewer signals of distress or desire for proximity with primary caregiver, which can influence attachment
Self-recognition often delayed, but positive
Problems in the development of self-other understanding
Deficits in social skills and social-cognitive ability; can lead to rejection by peers

23. Emotional and Behavioral Problems
Emotional and behavioral disturbances four times greater than the general population
Impulse control problems, anxiety problems, and mood problems common
ADHD-related symptoms also common
Pica and self-injurious behavior also common among those with severe and profound MR

24. Other Disabilities Associated with MR
Can be associated with other pervasive physical and developmental disabilities, including sensory impairments, cerebral palsy, and epilepsy
Chance of other disability increases as degree of intellectual impairment increases

25. Other Disabilities Associated with MR (cont.)

26. Etiology The causes of mental retardation are many and varied
In some cases, pathology of a physiological or biological nature can be identified
for as many as 30–40% of those with mental retardation, causation is unknown

28. Causes of MR
Genetic Causes (65%) Chromosomal defects; Structural anomalies;Inborn errors of metabolism  
Intrauterine Risk Factors (15%) Asphyxia; Developmental defects; Malnutrition/ Intrauterine growth retardation Maternal infections or diseases; Maternal substance abuse 
Perinatal Risk Factors (10%):Anoxia; Birth trauma;Low birth weight;Prematurity
Neonatal and Postnatal Causes (10%):Childhood infections and diseases; Environmental toxins; Severe malnutrition, Trauma 

29. Causes of Mental Retardation
Many organic causes have been discovered but majority of cases cannot be explained, especially for mild mental retardation
The two-group approach:
organic mental retardation- includes chromosome abnormalities, single gene conditions, and neurobiological influences
cultural-familial mental retardation- includes family history of mental retardation, economic deprivation, inadequate child care, poor nutrition, and parental psychopathology

30. Causes of Mental Retardation (cont.)
Inheritance and the Role of the Environment
heritability of intelligence is approximately 50%
prenatal influences may be mistaken for genetic when they are actually environmental

31. Causes of Mental Retardation (cont.)

32. Causes of Mental Retardation
Genetic and Constitutional Factors
chromosomal abnormalities are the most common cause of severe MR
Down syndrome due to an additional 21st chromosome
Fragile-X syndrome, the most common cause of inherited MR, is associated with the FMR-1 gene
Prader-Willi and Angelman syndromes both associated with abnormality of chromosome 15; believed to be spontaneous genetic birth defects occurring around the time of conception
inborn errors of metabolism (referred to as single-gene conditions) can result in syndromes such as PKU

33. Causes of Mental Retardation (cont.)
Neurobiological influences
adverse biological conditions (e.g., malnutrition, exposure to toxins, Rubella, prenatal and perinatal stressors)
infections, traumas, and accidental poisonings during infancy and childhood
prenatal alcohol exposure can lead to a Fetal Alcohol Spectrum Disorder (FASD)
Social and Psychological influences
deprivation of physical and emotional care and social stimulation particularly influential

34. Genetic Factors Down syndrome
three types of Down syndrome, each resulting from a different type of chromosomal error.
Nondisjunction
Translocation
Mosaicism

36. Mental Retardation: Trisomy 21
Distinctive facial features
Mild MR
Parental age
Medical complications

38. Mental Retardation: Fragile X
Physical characteristics
Females vs. Males
Autism

40. Genetic Factors
phenylketonuria (PKU), an inherited metabolic disorder that occurs in about 1 of every 10,000 live births
Affected infants lack the ability to process phenylalanine, severely damages the central nervous system

41. Mental Retardation: PKU (genetic)
Phenylalanine metabolizing deficiency MR
Restricted diet

42. Genetic Factors Maple syrup urine disease
Affected infants tend to excrete urine that has a distinctive odor of maple syrup
may cause severe intellectual impairment, although more often than not the condition is fatal
cause of this condition has been linked to metabolic deficiencies of three separate amino acids causing extreme CNS damage in the newborn
Untreated maple syrup urine disease is fatal; few untreated infants survive more than a few weeks

43. Genetic Factors
Galactosemia involves difficulty in carbohydrate (sugar) metabolism, rather than amino acid metabolism
Infants with galactosemia are unable to properly process certain sugar components in milk
Results are toxic damage to the infant’s liver, brain, and other tissues

46. Prevention, Education, Treatment
Child’s overall adjustment is a function of parental participation, family resources, social supports, level of intellectual deficit, temperament, and other specific deficits
Treatment involves a multi-component, integrated strategy that considers children’s needs within the context of their individual development, family and institutional setting, and community
Prenatal education and screening may prevent some cases of MR

47. Treatment of children with mental retardation
Three types of prenatal intervention
Chromosomal analysis for Down Syndrome or other genetic abnormalities may result decision to abort fetus
Treatment for Rh blood incompatibility between mother and fetus may prevent fetal damage.
Prenatal identification of a PKU problem may result in maternal dietary restrictions

49. Prevention, Education, Treatment (cont.)
Risk and protective factors affecting the psychological adjustment of intellectually disabled children

50. Prevention, Education, Treatment (cont.)
Psychosocial treatments
intensive, child-focused, early intervention efforts are very promising (particularly for disadvantaged children)
optimal timing for intervention is in the preschool years
behavioral techniques include shaping, modeling, graduated guidance, and social skills training
cognitive-behavioral techniques, such as self-instructional training and metacognitive training
family oriented interventions help families cope with the demands of raising a child with MR

52. Postnatal Interventions
Infant stimulation programs provide positive developmental environment for very young children who are at risk because of prenatal or later environmental circumstances
Specific instruction for young children in language skills appears promising and probably should be implemented as early as possible
Inclusion of young children of school age in classrooms with non disabled peers

54. “Intellectual Disabilities” adopted by
Continuous name shift
“Mental Retardation” and “Learning Disabilities” are outdated and unacceptable for users
“Intellectual Disabilities” adopted by
IASSID / AAMR
US President´s Commission
DSM-IVTR 2005

55. Post test Custodial MR ???? Severe MR ???? %
Sex >>>>>> ????
Peer bahavior ????
Intellectual disability ????

56. WITH
THANKS
DR SEDDIGH