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Chapter 9

Chapter 9 Intellectual Disability (Mental Retardation)

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Western University
Psychology 2320A/B
Elizabeth Hayden

Chapter 9: Intellectual Disability (Mental Retardation)  Intellectual disability and mental retardation used interchangeably  Intellectual disability (ID) – characterized by significant limitations in both intellectual functioning and adaptive behaviour that begin before age 18  Mental retardation appears on Axis II in the DSM-IV-TR because it is considered a stable condition rather than a clinical disorder Intelligence and Intellectual Disability  The Eugenics Scare o Eugenics was first defined by Sir Francis Galton as “the science which deals with all influences that improve the inborn qualities of a race” o Public/professional emphasis shifted away from the needs of persons with mental retardation toward a consideration of the needs of society – thus, society was to be protected from the presumable harm that would be done by the presence of these persons o Consequently, the appearance, belief, and behaviour of persons with mental retardation were considered evidence of their lack of moral fiber, a belief that led to the diagnostic term moron, used to explain and describe their differences  Defining and Measuring Children’s Intelligence and Adaptive Behaviour o General intellectual functioning – defined by an intelligence quotient (IQ or equivalent) that is based on assessment with one or more of the standardized, individually administered intelligence tests, such as the WISC-IV, SB5 and KABC-II  These tests assess various verbal and visual-spatial skills in the child and mathematical concepts, which together are presumed to constitute the general construct known as intelligence  IQ scores (with mean of 100 and standard deviation of 15) are derived from a standardized table based on a person’s age and test score  Because intelligence is defined along a normal distribution, approx. 95% of the population has scores within 2 standard deviations of the mean (i.e. between 70 and 130)  Subaverage intellectual functioning is defined as an IQ of about 70 or below o Definition of mental retardation includes not only subaverage intellectual functioning, but also subaverage level of adaptive functioning – refers to how effectively individuals cope with ordinary life demands, and how capable they are of living independently and abiding by community standards  The Controversial IQ o IQ generally is stable from childhood through adulthood  One exception to this rule is during early infancy, when considerable fluctuation can still occur o But can change for some individuals between childhood and adolescence – differences I noutcome vary widely in relation to opportunities for each child to learn and develop Features of Intellectual Disabilities  Clinical description o DSM-IV-TR diagnostic criteria consists of three core features:  Individuals must have “significant subaverage intellectual functioning” – individual must have IQ of 70 or below, which falls 2 standard deviations below the average and therefore include rougly 2 – 3%  Requires “concurrent deficits/impairments in adaptive functioning” – refers to the ability to perform daily activities  A person must also show significant limitations in at least two areas of adaptive behaviour such as communication, self-care, social/interpersonal skills or functional academic or work skills  Child’s below-average intellectual and adaptive abilities must be evident prior to age 18  Acknowledges that mental retardation is a developmental disorder that is evident during childhood and adolescence  Age criterion rules out persons who may show mental deficiencies caused by adult- onset degenerative diseases such as Alzheimer’s disease or head trauma  Degrees of impairment o Because of wide variation in cognitive functioning and impairment, DSM-IV-TR designates retardation as mild, moderate, severe or profound based primarily on IQ scores o Persons with mild mental retardation (IQ level 55 – 70) constitute the largest group, estimated to be as many as 85% of persons with the disorder  Often show small delays in development during preschool years, but not identified until academic or behavior problems emerge during early elementary  Typically develop social/communication skills during the preschool years, with delays in expressive language, minimal or no sensorimotor impairment and engage with peers readily  With appropriate support, usually live successfully independently or in supervised settings o Persons with moderate mental retardation (IQ level 40 – 54) constitute about 10% of those with ID  More intellectually and adaptively impaired than someone with mild mental retardation, and usually are identified during the preschool years when delays in early developmental milestones are shown  Communicate through a combination of single words and gestures, and show self-care and motor skills similar to an average 2-3 year old by the time they enter school  Benefit from various types of training such as vocational training, and training in social and communicational skills  Some may require only a few supportive services whereas others may continue to require some help throughout life o Those with severe mental retardation (IQ level 25 – 39) constitute approx. 3% to 4% of persons with ID  Most suffer one or more organic causes of retardation, such as genetic deficits, and are identified at a very young age because they have substantial delays in development and visible physical features/anomalies  In addition to intellectual impairment, may have problems with physical mobility or other health-related problems such as respiratory, heart or physical complications  Most require special assistance throughout their lives  Acquire little or no communicative speech during early childhood, and by age 12, they may use some two to three-word phrases  Between 13-15, academic and adaptive abilities are similar to those of an average 4 to 6 year old o Persons with profound mental retardation (IQ level below 20 – 25) constitute approx. 1 – 2% of those with ID  Identified typically in infancy because of marked delays in development and biological anomalies such as asymmetrical facial features  Show considerable impairments in sensorimotor functioning in early childhood, and are only able to learn the rudiments of communication skills; require intensive training to learn basic eating, grooming, and dressing behaviors  Require lifelong care and assistance and have severe co-occurring medical conditions such as heart defects or epilepsy  Level of needed supports o DSM-IV-TR has been criticized because it emphasizes the degree of impairment o American Association on Intellectual and Developmental Disabilities (AAIDD) focuses on levels of needed support and assistance  Emphasizes resources and strategies necessary to promote the overall adjustment and well- being of a person with ID  Some AAIDD categories include employment activities, home living activities, health and safety activities, social activities, behavioural activities, etc.  Race, sex, and SES prevalence o Between 1-3% of the entire population o About twice as many males as females among those with mild mental retardation, with this sex ratio decreasing to 1.5:1.0 among those with more severe forms o More prevalent among children of lower SES and children from minority groups (mild form) o Children with more severe levels are identified equally in different racial/economic groups Developmental Course and Adult Outcomes  Chromosome abnormalities are the single most common cause of moderate to severe mental retardation o Down syndrome is the most common disorder resulting from such abnormalities  Developmental-versus-difference controversy – debate regarding developmental progression of children with mental impairments o Developmental – argues that all children progress through same developmental stages but at different rates o Difference – argues that development of children with mental impairments proceeds in different, less sequential, and less organized fashion  Motivation – more susceptible to a sense of helplessness and frustration – places additional burdens on their social/cognitive development  Changes in abilities – not necessarily a lifelong disorder, relatively stable from childhood to adolescence, but IQ scores can fluctuate in relation to level of impairment and type of retardation  Language and social behaviour – most striking difference is the delay in expressive language development, which is necessary to establish independent living skills o Also have problems forming secure attachments because they express less emotion than others o Show delay and aberrant functioning in internal state language – language that reflects the emergent sense of self and others  Internal state language is critical to regulating social interaction and providing a foundation for early self-other understanding – thus children with ID are at increased risk for subsequent problems in the development of self-system o Often fail to gain their peers’ acceptance in regular education settings, because of deficits in social skills and social-cognitive ability  Emotional and behavioural problems o Internalizing problems – increased risk for mood disorders and other internalizing symptoms of depression and social withdrawal o ADHD-related symptoms o Other symptoms  Self-injurious behaviour (SIB) – serious and sometimes life-thr
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