MENTAL MENTAL RETARDATION RETARDATION

and and HEARING HEARING

IMPAIRMENTIMPAIRMENT

A Presentation By:A Presentation By:Jill Angelique B. LimasJill Angelique B. Limas

andandCheryl L. LobianoCheryl L. Lobiano

DEFINITION of DEFINITION of MENTAL RETARDATIONMENTAL RETARDATION

• sub-average intellectual sub-average intellectual functioningfunctioning, existing concurrently , existing concurrently with with deficits in adaptive behaviordeficits in adaptive behavior and and manifested during the manifested during the developmental perioddevelopmental period that that adversely affects a child’s adversely affects a child’s educational performance educational performance

What is Intellectual What is Intellectual Functioning Level?Functioning Level?

• Intellectual functioning level is Intellectual functioning level is defined by standardized tests defined by standardized tests that measure the ability to that measure the ability to reason in terms of mental age reason in terms of mental age (intelligence quotient or IQ). (intelligence quotient or IQ).

• Mental retardation is defined as Mental retardation is defined as an IQ score below 70–75.an IQ score below 70–75.

What are Adaptive Skills?What are Adaptive Skills?• Refers To Skills Needed For Daily Life.Refers To Skills Needed For Daily Life. CommunicationCommunication Self careSelf care Social skillsSocial skills Home-living skillsHome-living skills LeisureLeisure Health and safetyHealth and safety Self-directionSelf-direction Functional academicsFunctional academics Community useCommunity use WorkWork

PREVALENCEPREVALENCE

• AAMR – estimates that 2.5% of the AAMR – estimates that 2.5% of the population has mental retardationpopulation has mental retardation

• The Arc – estimates at 3% of the The Arc – estimates at 3% of the population has this disabilitypopulation has this disability

• Ratio between boys and girls is at Ratio between boys and girls is at 1.5:11.5:1

CAUSES of MENTAL CAUSES of MENTAL RETARDATION:RETARDATION:

• Genetic FactorsGenetic Factors• Pre-natal Illnesses and IssuesPre-natal Illnesses and Issues• Childhood Illnesses and IssuesChildhood Illnesses and Issues• Environmental FactorsEnvironmental Factors

Genetic FactorsGenetic Factors• 30% of cases30% of cases• May be caused by an inherited May be caused by an inherited

genetic abnormalitygenetic abnormality– Fragile x syndromeFragile x syndrome– Single gene defectsSingle gene defects– Accident or mutation in genetic Accident or mutation in genetic

developementdevelopement

Pre-natal Illnesses and IssuesPre-natal Illnesses and Issues

• Fetal alcohol syndrome (FAS) Fetal alcohol syndrome (FAS) • Maternal infections and illnesses Maternal infections and illnesses

- glandular disorders, rubella, glandular disorders, rubella, toxoplasmosis, and cytomegalovirus toxoplasmosis, and cytomegalovirus (CMV) infection(CMV) infection

- high blood pressure (hypertension)high blood pressure (hypertension)

blood poisoning (toxemia)blood poisoning (toxemia)

• Birth defects that cause physical Birth defects that cause physical deformities of the head, brain, deformities of the head, brain, and central nervous systemand central nervous system

Childhood Illnesses and Childhood Illnesses and InjuriesInjuries

• HyperthyroidismHyperthyroidism• Whooping coughWhooping cough• MeaslesMeasles• ChickenpoxChickenpox• Hib diseaseHib disease• MeningitisMeningitis• EncephalitisEncephalitis• Traumatic brain injuryTraumatic brain injury

Environmental FactorsEnvironmental Factors

• Ignored or neglected infantsIgnored or neglected infants• Children who live in poverty and Children who live in poverty and

suffer from malnutritionsuffer from malnutrition• unhealthy living conditionsunhealthy living conditions• AbuseAbuse• improper or inadequate medical improper or inadequate medical

carecare

Characteristics of MRCharacteristics of MR

• LEARNING CHARACTERISTICSLEARNING CHARACTERISTICSAttention - difficulty focusing their Attention - difficulty focusing their

attention, maintaining it, selectively attention, maintaining it, selectively attending to relevant stimuli, less attending to relevant stimuli, less attention to allocate, they do not attention to allocate, they do not know how to attend to the relevant know how to attend to the relevant aspects of dimensions of the aspects of dimensions of the problem. problem.

Memory - ability to remember information; Memory - ability to remember information; factors that may contribute to the memory factors that may contribute to the memory difficulties of persons with mental retardation difficulties of persons with mental retardation include problems attending to relevant stimuli, include problems attending to relevant stimuli, inefficient rehearsal strategies, and an inability to inefficient rehearsal strategies, and an inability to generalize skills to novel settings or tasks.generalize skills to novel settings or tasks.

Academic Performance - Students with mental Academic Performance - Students with mental retardation usually have to work harder and retardation usually have to work harder and practice longer than other students in order to practice longer than other students in order to learn academic skills, this deficiency is seen learn academic skills, this deficiency is seen across all subject areas, but reading appears to across all subject areas, but reading appears to be the weakest area, specially reading be the weakest area, specially reading comprehension; they are also deficient in comprehension; they are also deficient in arithmeticarithmetic

• Motivation - Past experiences with failure typically Motivation - Past experiences with failure typically lead individuals with mental retardation to exhibit lead individuals with mental retardation to exhibit an external locus - they are likely to believe that the an external locus - they are likely to believe that the outcomes of their behavior are the result of outcomes of their behavior are the result of circumstances and events beyond their personal circumstances and events beyond their personal controlcontrol, rather than their efforts. Repeated episodes , rather than their efforts. Repeated episodes of failure also give rise of failure also give rise learned helplessnesslearned helplessness - the - the perception that perception that no matter how much effort they put no matter how much effort they put forth, failure is inevitableforth, failure is inevitable. Accumulated experiences . Accumulated experiences with failure also result in a style of learning and with failure also result in a style of learning and problem solving characterized as problem solving characterized as ouster-ouster-directednessdirectedness - a - a loss of confidence and trust in loss of confidence and trust in one’s own abilities and solutions and a reliance on one’s own abilities and solutions and a reliance on others for cues and guidanceothers for cues and guidance

• Generalization - the ability to learn a task Generalization - the ability to learn a task or idea then apply it in other situations. or idea then apply it in other situations. Learning in someone who is mentally Learning in someone who is mentally retarded is situation specific. retarded is situation specific. Generalization of responses can be Generalization of responses can be facilitated (e.g. by using concrete facilitated (e.g. by using concrete materials rather than abstract materials rather than abstract representations; by providing instruction representations; by providing instruction in various settings where the strategies of in various settings where the strategies of skill will typically be used; by skill will typically be used; by incorporating a variety of examples and incorporating a variety of examples and materials; or by simply informing the materials; or by simply informing the pupils of the multiple applications that are pupils of the multiple applications that are possible).possible).

• Language Development – delays in Language Development – delays in development of language; vocabulary development of language; vocabulary more limited; grammatical structure more limited; grammatical structure and sentence complexity are often and sentence complexity are often impaired; speech disorders are common impaired; speech disorders are common (e.g errors of articulation – additions or (e.g errors of articulation – additions or distortions); fluency disorders distortions); fluency disorders (stuttering); voice disorders (hyper-(stuttering); voice disorders (hyper-nasal speech or concerns about nasal speech or concerns about loudness).loudness).

• SOCIAL & BEHAVIORAL CHARACTERISTICSSOCIAL & BEHAVIORAL CHARACTERISTICSSocial problems – poor interpersonal skills, Social problems – poor interpersonal skills,

socially inappropriate or immature socially inappropriate or immature behaviorbehavior

Emotional problems – loneliness and Emotional problems – loneliness and depressiondepression

Behavioral problems – compulsive eating, Behavioral problems – compulsive eating, hair pulling, bitinghair pulling, biting

Adaptive behavior problemsAdaptive behavior problems

• PHYSICAL & MEDICAL CHARACTERISTICSPHYSICAL & MEDICAL CHARACTERISTICSLess physically fitLess physically fit

HISTORYHISTORY

• Ancient Greece and Rome – infacticideAncient Greece and Rome – infacticide• 22ndnd Century AD – sold for Century AD – sold for

entertainmententertainment• Dawning of Christianity - movement Dawning of Christianity - movement

toward care for the less fortunate toward care for the less fortunate • Jesus, Buddha, Mohammed, Confucius Jesus, Buddha, Mohammed, Confucius

- advocated human treatment for the - advocated human treatment for the mentally retarded, developmentally mentally retarded, developmentally disabled, or infirmed disabled, or infirmed

• Middle ages (476 - 1799 A.D.) - the status and Middle ages (476 - 1799 A.D.) - the status and care of individuals with mental retardation care of individuals with mental retardation varied greatly: more human practices evolved varied greatly: more human practices evolved but many children were sold into slavery, but many children were sold into slavery, abandoned, or left out in the cold abandoned, or left out in the cold

• 1690 - John Locke published his famous work 1690 - John Locke published his famous work ““An Essay Concerning Human Understanding”An Essay Concerning Human Understanding”

• 1790 - Jean-Marc-Gaspard Itard published an 1790 - Jean-Marc-Gaspard Itard published an account of his work with Victor, the Wild Boy account of his work with Victor, the Wild Boy of Aveyron.of Aveyron.

• 1848 – Edouard Seguin helped establish the 1848 – Edouard Seguin helped establish the Pennsylvania Training SchoolPennsylvania Training School

• 1850 - Samuel Gridley Howe began the 1850 - Samuel Gridley Howe began the School of Idiotic and Feeble Minded YouthSchool of Idiotic and Feeble Minded Youth

• 1896 - the first public school class for 1896 - the first public school class for children with mental retardation began in children with mental retardation began in Providence, RI.Providence, RI.

• 1905 - Alfred Binet and Theodore Simon 1905 - Alfred Binet and Theodore Simon developed a test in France to screen developed a test in France to screen students not benefiting from regular students not benefiting from regular curriculumcurriculum

• 1916 – Lewis Terman of Stanford 1916 – Lewis Terman of Stanford University published the Stanford-Binet University published the Stanford-Binet Intelligence Scale in the US.Intelligence Scale in the US.

• 1935 – Edgar Doll published the Vineyard 1935 – Edgar Doll published the Vineyard Social Maturity Scale.Social Maturity Scale.

• 1950 – Parents formed the National Association 1950 – Parents formed the National Association for Retarded Children (The Arc)for Retarded Children (The Arc)

• 1959 - AAMR published its first manual on the 1959 - AAMR published its first manual on the definition and classification of mental definition and classification of mental retardation, with diagnosis based on an IQ retardation, with diagnosis based on an IQ score of one standard deviation below the mean score of one standard deviation below the mean (approximately 85)(approximately 85)

• 1961 – John F. Kennedy established the first 1961 – John F. Kennedy established the first President’s Panel on Mental RetardationPresident’s Panel on Mental Retardation

• 1969 – Bengt Nirje published a key paper 1969 – Bengt Nirje published a key paper defining normalization. Wolf Wolfensberger defining normalization. Wolf Wolfensberger championed normalization in the United States.championed normalization in the United States.

• 1973 – AAMR published a revised definition 1973 – AAMR published a revised definition that required a score on IQ tests of two that required a score on IQ tests of two standard deviations below the mean standard deviations below the mean (approximately 70 or less) and concurrent (approximately 70 or less) and concurrent deficits in adaptive behavior.deficits in adaptive behavior.

• 1975 - United States Congress passed the 1975 - United States Congress passed the Education for the Handicapped Act, now titled Education for the Handicapped Act, now titled the Individuals with Disabilities Education Act the Individuals with Disabilities Education Act - guaranteed the appropriate education of all - guaranteed the appropriate education of all children with mental retardation and children with mental retardation and developmental disabilities, from school age developmental disabilities, from school age through 21 years of age through 21 years of age

• 1986 – IDEA was amended to guarantee 1986 – IDEA was amended to guarantee educational services to children with educational services to children with disabilities age 3 through 21 and provided disabilities age 3 through 21 and provided incentives for states to develop infant and incentives for states to develop infant and toddler service delivery systems toddler service delivery systems

• 1992 - AAMR published “System 92” a 1992 - AAMR published “System 92” a radically different definition of mental radically different definition of mental retardation with a classification system retardation with a classification system based on intensities of supports.based on intensities of supports.

• 2002 – AAMR published revision of the 2002 – AAMR published revision of the 1992 definition; retains classification by 1992 definition; retains classification by intensities of supports; returns to IQ of intensities of supports; returns to IQ of approximately two standard deviations approximately two standard deviations below mean; adds social participation and below mean; adds social participation and interactions as fifth dimension of interactions as fifth dimension of functioning.functioning.

CLASSIFICATION of MRCLASSIFICATION of MR

• MildMild• ModerateModerate• SevereSevere• ProfoundProfound

MildMild Mental Retardation Mental Retardation

• 85% of the mentally retarded85% of the mentally retarded• IQ score ranges from 50-75IQ score ranges from 50-75• often acquire academic skills up to often acquire academic skills up to

the 6th grade levelthe 6th grade level• can become fairly self-sufficient can become fairly self-sufficient

and in some cases live and in some cases live independently, with community independently, with community and social supportand social support

ModerateModerate Mental Mental RetardationRetardation

• 10% of the mentally retarded10% of the mentally retarded• IQ scores ranging from 35-55IQ scores ranging from 35-55• can carry out work and self-care tasks can carry out work and self-care tasks

with moderate supervisionwith moderate supervision• typically acquire communication skills typically acquire communication skills

in childhoodin childhood• able to live and function successfully able to live and function successfully

within the community in a supervised within the community in a supervised environmentenvironment

SevereSevere Mental Retardation Mental Retardation

• 3-4% of the mentally retarded3-4% of the mentally retarded• IQ scores of 20-40 IQ scores of 20-40 • may master very basic self-care may master very basic self-care

skills and some communication skillsskills and some communication skills• able to live in a group homeable to live in a group home

ProfoundProfound Mental Mental RetardationRetardation

• 1-2% of the mentally retarded 1-2% of the mentally retarded • IQ scores under 20-25IQ scores under 20-25• may be able to develop basic self-may be able to develop basic self-

care and communication skills with care and communication skills with appropriate support and trainingappropriate support and training

• need a high level of structure and need a high level of structure and supervisionsupervision

TREATMENT TREATMENT and MEDICATIONand MEDICATION

• no treatments are available no treatments are available specifically for cognitive deficiency specifically for cognitive deficiency

• develop a comprehensive develop a comprehensive management plan for the condition management plan for the condition

• requires input from care providers requires input from care providers from multiple disciplines - special from multiple disciplines - special educators, language therapists, educators, language therapists, behavioral therapists, occupational behavioral therapists, occupational therapists, and community services therapists, and community services

• THANK YOU!!!THANK YOU!!!