Mental Retardation:
Assessment and
Treatment
September 11, 2007
Historical Perspectives

Historically, prevailing sentiment was
one of ignorance and mistreatment

Degeneracy theory (1800’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
Prevalence
– 1-3% of population


Slightly more males than females
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
The two-group approach:
– organic
– cultural-familial
Diagnosing Mental
Retardation

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

Mild (IQ: 55-70)

Moderate (IQ: 40-54)

Severe (IQ: 25-39)

Profound (IQ: below 25 or 20)
Other Categorization

American Association on Mental Retardation
(AAMR) categories:
–
–
–
–

intermittent
limited
extensive
pervasive
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
MR criteria: Impairment in two or
more areas
Vineland Adaptive
Behavior Scales

Assesses adaptive behavior (birth-18
years)
– Sub-domains:
Communication
 Daily Living Skills
 Socialization
 Motor Skills

– Adaptive Behavior Composite
Age Criteria


Must be evident before age 18
Why?
– Developmental Disorder
– Rule Out: Adult Degenerative Diseases
Does our patient meet
criteria for mental
retardation?
Diagnostic Criteria

IQ at or below 70
– Intelligence testing = 68 IQ

Significant impairment in 2 or more
areas of adaptive functioning
– Impairments in communication, daily
living skills, socialization

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?
– Can they still go to college?

Who will take care of my child when I
die?
– Will they be institutionalized?

Concerns about stigma
– “Don’t tell the school!”
– Diagnosis refusal/denial
Specific concerns




Labeling
Stigma
Self-fulfilling prophesy
Learned helplessness
Treatment

Early intervention is critical
– Optimal time: Preschool years





Encourage exploration
Teach basic skills
Celebrate achievements
Rehearsal, rehearsal, rehearsal
Protection from teasing/social rejection
Video: David’s Story
Concluding Statements




Wide variability in functioning
Importance of environment
Important to address affective
response to diagnosis
Do not let labels fool you!