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Mr2008 Mr2008 Presentation Transcript

  • 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
  • Intelligence © 2006, Prentice Hall, Wicks-Nelson
  • Definition and diagnosis:
    • AAMR 1992
    • MR 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 considered
      • mild MR instable
      • mild MR and schooling
      • death 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 frameworks
    • I . 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
    • info rmation 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
    •  
  • 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
    © 2006, Prentice Hall, Wicks-Nelson
  •  
  • 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
  • Trisomy 21 © 2006, Prentice Hall, Wicks-Nelson
  • 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
  • Genetic Syndromes
    • Williams Syndrome
      • Rare
      • Deletions on Chromosome 7
      • Mild to moderate MR
      • General knowledge & visual spatial deficits
      • Relative strengths in language
      • Elfin appearance
    © 2006, Prentice Hall, Wicks-Nelson
  • Visual Spatial Deficits © 2006, Prentice Hall, Wicks-Nelson
  • Multifactor Causation
    • Current theories posit a complicated interaction between biology and environment (Table 11-9)
    © 2006, Prentice Hall, Wicks-Nelson
  •  
  •  
  • ETIOLOGIES
    • “ two group approach”  
    • organic familial
    • social function marked 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
  • Behavioral Problems and Co-occurring Diagnoses
    • These include:
      • Depression
      • Attention Problems and Hyperactivity
      • Aggression
      • Obsessive-compulsive behavior
      • Schizophrenia
      • Autism
      • Stereotyped behavior
      • Self Injurious Behavior
    © 2006, Prentice Hall, Wicks-Nelson