Chapter 5
Persons with Mental Retardation
AAMR Definitions
• Since 1876 the American Association on
Mental Retardation has revised its
definition of mental retardation eleven
times
– Revisions reflected change
• Terminology
• Classification
• Expectations
AAMR : Significantly Subaverage
Intellectual Functioning
Intelligence Levels
1961
1973
1983
< 85 or 1 SD
<70 or 2 SD
< 70-75
Normal
Distribution
Normal Distribution
Bell Curve
Theories and Tests of
Intelligence
• IQ tests
– Intelligence quotient (IQ) tests
attempt to measure an individual’s
probable performance in school and
similar settings.
Binet (1857-1911) and Simon created 1st IQ
←
test in 1905
Theories and Tests of
Intelligence
• The Stanford-Binet test
– The Stanford-Binet test - V (2-85)
– The mean or average IQ score for all
age groups is designated as 100 ± 15
(85-115).
– Given individually
Individual Intelligence Tests
The Wechsler Scales
Overall IQ and also verbal and performance
IQs.
(WPPSI-III) Wechsler Preschool and Primary
Scale of Intelligence-Revised. Ages 2 ½ to 7
years, 3 months
(WISC-IV) Wechsler Intelligence Scale for
Children-Revised. Ages 6 to 16 years, 11
months
(WAIS-III) Wechsler Adult Intelligence ScaleRevised
Ages 16-89
WPPSI-III
WPPSI
•
•
•
•
•
WISC-IV
Word Reasoning—measures reasoning with verbal material; child
identifies underlying concept given successive clues.
Matrix Reasoning—measures fluid reasoning a (highly reliable
subtest on WAIS® –III and WPPSI™–III); child is presented with a
partially filled grid and asked to select the item that properly
completes the matrix.
Picture Concepts—measures fluid reasoning, perceptual
organization, and categorization (requires categorical reasoning
without a verbal response); from each of two or three rows of
objects, child selects objects that go together based on an
underlying concept.
Letter-Number Sequencing—measures working memory
(adapted from WAIS–III); child is presented a mixed series of
numbers and letters and repeats them numbers first (in numerical
order), then letters (in alphabetical order).
Cancellation—measures processing speed using random and
structured animal target forms (foils are common non-animal
objects).
Pitfalls of IQ Testing
• There is a potential for cultural bias
because of the highly verbal nature of the
test and the reflection of middle-class
Anglo standards
• IQ is not static but capable of changing
• Overemphasis on IQ scores as the sole
indicator of a person’s worth reduces the
value of other factors such as adaptive
skills
1992 AAMR Definition
• Significantly subaverage intellectual ability
• Exists concurrently with limitations in two
or more adaptive skill areas
• Manifests before age 18
• Adaptive skill areas: communication, selfcare, home living, social skills, community
use, self direction, health and safety,
functional academics, leisure, and work
2002 AAMR Definition
• Characterized by signification limitations
both in intellectual functioning and in
adaptive behavior
• Adaptive behavior expressed in
conceptual, social, and practical adaptive
skill
• Disability originates before age 18
Five Assumptions of the 2002
AAMR Definition
• Limitations occur within the community
environment & consider age, peers, and culture
• Limitations often coexist with strengths
• Limitation identification profiles need supports
• Valid assessment considers differences in
culture, language, as well as communication,
sensory, motor, and behavioral factors
• With appropriate personalized supports, the life
functioning of an individual with mental
retardation will generally improve
Adaptive Behavior
• Measured by test instruments
– AAMR Adaptive Behavior Scale—School
– AAMR Adaptive Behavior Scale—Residential
and Community
– Vineland Social Maturity Scale
• Assess areas of personal responsibility,
daily living skills, social adaptations, and
maladaptive behavior as they occur within
the demands of everyday life
Classification Schemas
• Etiological Perspective
– Established by medical or biological causes
• Intellectual Deficit
– Determined by IQ testing
• Educational Perspective
– Based on anticipated educational
accomplishments, educable or trainable
• Levels of Support
– Intermittent, limited, extensive, or pervasive;
natural or formal
The Dynamics of
Intelligence
The History of Mental Retardation I
• The Greek Empires
– Sparta: valued physical strength and
intellectual ability; infanticide, eugenics
– Athens: unwanted newborns placed into a jar
at the temple doors; eventually sold as slaves
• The Roman Republic
– During first 8 days of life infants were allowed
to perish; Columana Lactaria; mutilated to
heighten their value as future beggars
The History of Mental Retardation II
• Middle Ages- a time of contrasts
– Les Enfants du Bon Dieu; valued as agrarian
workers; treasured as court jesters
– King Henry II of England declared “natural
fools” wards of the king
– Superstition, witchcraft, demonic possession,
imprisoned as a danger to society
– Renaissance embraces humanism
The History of Mental Retardation III
• Early Optimism
– Esquirol (1782-1840): Amentia (without mind)
• Imbeciles- mild mental retardation
• Idiots- severe, profound mental retardation
– Itard (1774-1838): Victor the wild man
• Father of Special Education- individuals with
mental retardation are capable of learning
The History of Mental Retardation IV
• Early Optimism (continued)
– Seguin (1812-1880): Paris school promoted
physiological and moral education
• Founded Association of Medical Officers of
American Institutions for the Feeble-minded
Persons, the forerunner to the AAMR
– Howe (1801-1876): First residential school
promoted reintegration and rehabilitation
The History of Mental Retardation V
• Protection and Pessimism (1860-1960)
– 1927 US Supreme Court (Buck v. Bell) upheld
sterilization of genetic misfits
– Institutions become permanent residences
often with deplorable living conditions
• Christmas in Purgatory by Blatt and Kaplan
(1966)
• The 1970’s
– Normalization
– Deinstitutionalization
The History of Mental Retardation VI
• Public Education
– First school in Providence, Rhode Island
(1890’s)
– By 1930, sixteen states offered special
classes for children with mental retardation
– By 1952, forty-six of the forty-eight states
• Until late 1950’s children with severe and profound
mental retardation were excluded from public
education
The History of Mental Retardation VII
• Kennedy Era (1960’s)
– President’s Panel on Mental Retardation
– Introduced an era of national concern for the
rights of individuals
– Eventual increase in federal aid to education
– Establishment of comprehensive communitybased program
– Educational rights
– Movement toward less restrictive and more
integrated educational placements
Prevalence (US Department of
Education, 2002)
• Students classified as mentally retarded
– Represent 11% of all pupils with a disability
– 1% of student population
– 612,978 individuals
– Has decreased 37% since 1975
• Changes in definition
• Impact of legislation
• Reluctance to identify children in minority groups
as mentally retarded
Etiology of Mental Retardation
• Prenatal: occurring before birth
• Perinatal: occurring around the time of
birth
• Postnatal: occurring after birth
Prenatal Factors
• Chromosomal
• Metabolic
• Nutritional
• Maternal Infections
• Fragile X, Down
syndrome
• Tay-Sachs, Prader
Willi syndrome
• Phenyketonuria,
galactosemia
• Rubella, AIDS,
syphillis, Rh factor,
CMV
FRAGILE X SYNDROME
eye & vision impairments
Hyper-extensible joints (double jointed)
elongated face
Large testicles (evident after puberty)
Flat feet
Low muscle tone
High arched palate
Autism and autistic-like behavior
Prominent ears
hand biting and hand-flapping
Mental Retardation
Hyperactivity and short attention span
Trisomy 21
TURNER SYNDROME (ONLY AN X
CHROMOSOME)
• short stature and lack of ovarian development, webbed neck, arms that
turn out slightly at the elbow, and a low hairline in the back of the head
are sometimes seen in Turner syndrome patients
Down Syndrome (Trisomy 21)
• Physical Deformities
flattening of the back of the head
slanting of the eyelids
short stubby limbs
thick tongues)
Environmental Factors
• Prenatal
• Postnatal
• Fetal alcohol
syndrome
• Drug use
• Child
abuse/neglect
• Head trauma
• Malnutrition
• Environmental
deprivation
Compromises in Brain Function
• Prenatal
• Anencephaly
• Hydrocephaly
• Microcephaly
• Postnatal
• Neurofribromatosis
• Tuberous sclerosis
Perinatal Factors
• Gestational
disorders
• Low birth weight
• Prematurity
• Neonatal
complications
•
•
•
•
Hypoxia
Birth trauma
Seizures
Respiratory
distress
• Breech/prolonged
delivery
Postnatal Factors
• Intoxicants
• Lead poisoning
• Complications of
childhood
infections
• Encephalitis
– Mumps, measles
• Meningitis
– Mumps, measles,
chicken pox
Prevention of Mental Retardation
• Primary Prevention
– Amniocentesis, chorionic villus sampling,
utlrasound, prenatal screening
• Secondary Prevention
– PKU and galactosemia screening following
birth, shunts for hydrocephalus
• Tertiary Prevention
– Early intervention, community based services
Services for Young Children with
Mental Retardation
• Early intervention (birth to 5)
• Family services and support rendered to
children with disabilities or children who
evidence risk factors
– Established risk
– Environmentally at risk
• Aims to positively effect social, emotional,
physical, and intellectual well being
Goals of Early Intervention
• Consortium of services working together to
minimize and if possible reverse the
impact of delay or deficits in normal
cognitive development on later school
performance
– Health care
– Social services
– Educational assistance
– Family centered support
Areas that Influence Learning
•
•
•
•
•
Attention
Memory
Academic performance
Motivation
Language development
Social and Behavioral
Characteristics
• May exhibit poor interpersonal skills
• May have difficulty in choosing the
appropriate social interaction
• Frequently encounter rejection by
classmates and peers
• Have difficulty maintaining friendships
Figure 5.5 Figure Represents Percentage of Enrollment of Students with Mental
Retardation During the 1999-2000 School Year
Educational Programming
• Functional curriculum
– Life skills
– Academic skills applied to everyday, practical
life situations (making change, following
directions)
• Functional academics
– Personal hygiene, independent living skills,
community resources
• Community Based Instruction
Points to Ponder
“ Although a functional curriculum is seen as
appropriate for many individuals with
mental retardation, in many ways it runs
counter to the basic tenets of the
philosophy of full inclusion with its
emphasis on age-grade- appropriate
placement.” (Garguilo)
Instructional Methodology
• Instructional methodologies and
accommodations that are used with pupils
who are mentally retarded are the same
ones that make learning successful for all
students (Friend & Bursuck, 2002)
• Reasonable accommodation for students
with special needs is within the capability
of the general educator
Instructional Methodology
•
•
•
•
•
INCLUDE
Task analysis
Cooperative learning
Unit approach
Scaffolding
INCLUDE
(Friend & Bursuck, 2002)
• Identify classroom environment, curricular,
and instructional demands
• Note student learning strengths and needs
• Check for potential areas of student success
• Look for potential problem areas
• Use information gathered to brainstorm
instructional adaptations
• Decide which adaptations to implement
• Evaluate student progress
Task Analysis
• Breaking of a complex task or behavior
into its’ component parts
– Select goals
– Identify prerequisite skills and materials
needed to perform the task
– Identify specific components of the task and
sequence component parts
– Evaluate instruction and task mastery level
– Seek to generalize skill to other settings
Cooperative Learning
• Teacher structured activity
– Small, heterogeneous groups
– Active involvement in accomplishing goal
– Individuals contribute according to ability
– Pupils with disabilities may require special
preparation for maximum participation
– Recognition and rewards based on group
performance
– Individual success contributes to the whole
Unit Approach
• Individual units designed to teach daily
living skills are taught within the content
areas
• Language arts
• Reading
• Mathematics
• Goals are adjusted for chronological age
and developmental levels
Scaffolding
• Introduce concept
• Present concept one step at a time using
simplified situations and guided practice
• Vary contexts for student practice
• Employ constructive feedback and
opportunity for self-evaluation
• Increase student responsibility to use the
strategies independently
• Provide extensive opportunity for practice
Transition into Adulthood
• Comprehensive and collaborative plan
responsive to the adolescent’s goals and
visions for adulthood
– Educators
– School personnel
– Adult service providers
– Family members
• Transition services are part of PL 101-476
and must be in place no later than age 16
Supported Competitive
Employment
• Cost effective
• Mutually beneficial to employee with a
disability and employer
• Job coaching enables adolescent to learn
specific job requirements on site
• Coaches match needs of employer to
abilities of the student worker
• Found to be more successful to promote
competitive employment skills than the
sheltered workshop model
Adults with Mental Retardation
• Normalization
– Maximizing personal control of life within the
norms and patterns of mainstream society
• Self-determination
– Independent decision making
• Self-advocacy
– Assertively stating want, needs, and desires
Assistive Technology
• Defined in IDEA
– Any item, piece of equipment, or product
system…acquired or commercial…that is
used to increase, maintain, or improve
functional capabilities
• Compensates for the functional limitation
of an individual and helps the person
function in a natural environment
Areas for Technology
• Activities of daily living
– Hygiene, meal preparation, e-mail
• Employment
– Computer skills, mobility, correspondence
• Sports and recreation
– Participation in activity, access to events
• Communication
– Written and verbal interactions, voice
Trends, Issues, and Controversies
• Increase in community-based activities
• Increasing need for assistive technology
• Assessment of quality of life and
normalization
• Existence of a growing geriatric population
• Increase in inclusive educational placements
• Fostering of self-advocacy and selfdetermination
• Ethical issues and hopes for biomedical
research