This special thematic volume in the International Review of Research in Mental Retardation focuses on motivation within this special population. The book explores several theoretical models of motivation, as well as discussing issues of goal orientation, self-regulated academic learning, the setting and monitoring of realistic goals, and social competence for people with mental retardation. Additional chapters discuss the measurement of subjective well-being and quality of life in this population, and strategies for empowering students with developmental difficulties as well as instructional practices and contexts that can enhance motivation, learning, and achievement.
Praise for the Series "In Under the editorship of Laraine Masters Glidden and a new editorial board, volumes have been published more often, with each issue having 8 to 10 integrative chapters. In contrast to earlier years, contributors to the past few volumes include more international workers, reflecting the burgeoning interest in mental retardation behavioral research in Britain, Australia, New Zealand, and other countries.
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Thanks in advance for your time. Skip to content. Search for books, journals or webpages Consistent with a developmental perspective, mental retardation is manifested before age Although certain aspects of this new definition depart from previous conceptions of mental retardation, the dual criteria of low IQ and deficits in adaptive behavior have been critical elements of most definitions for many years.
Defining mental retardation in terms of adaptive behavior deficits is especially important when considering the presence of co-occurring mental health problems. There has never been a universal consensus as to what mental retardation actually is. Moreover, at any time in history, the definition of mental retardation has reflected the current status of scientific knowledge and prevailing views on social issues related to mental retardation. From the turn of the century until the first formal AAMR definition in , mental retardation was widely believed to be a biologically based condition of the central nervous system, existing from birth, that was incurable and probably irremediable.
The AAMR definition was less restrictive, focusing on current functioning rather than constitutionality, and not explicitly stating that mental retardation was incurable. The assumption of a theoretically normal distribution of intelligence suggests that most people will have IQs that are closer to the mean score of i.
Thus, mild retardation comprises the largest group of people with mental retardation.
The arbitrariness of the concept of mental retardation is illustrated by the AAMR definitional change in , which moved the upper IQ limit from approximately 85 one standard deviation from the mean of down to 70 two standard deviations from the mean. For individuals with severe forms of mental retardation, these definitional differences were irrelevant; they would probably have been identified no matter what definition was used.
But, for those with IQs between about 70 and 85, who had been previously identified as having mental retardation, this decision changed their diagnosis. Today, the majority of children with mild forms of retardation do not have known pathology biologic origins. They are more likely to come from adverse economic and living situations that contain risk factors, such as poor nutrition, poor medical care, low motivation for personal achievement, and parents who have below average IQs.
For some children, these factors will result in depressed intellectual functioning, poor development of adaptive skills, and a diagnosis of retardation. Most formal organizations e. But because the AAMR definition and classification system is still rather new and has introduced some conceptual shifts, its long-term impact on the definitional criteria used by other organizations is unknown. For those people whose IQs are close to the cutoff, adaptive functioning is the key determinant in their diagnosis. It is the lack of adaptive competence, rather than low IQ, that usually leads to referral for evaluation and diagnosis.
Thus, many individuals with IQs below the cutoff will never be referred for evaluation if their levels of adaptive competence do not draw attention. From a sociological perspective, then, the values and expectations of each society determine how mental retardation is to be defined, that is, by identifying the types and degree of deviant behavior that is not tolerated.
This suggests that a diagnosis of mental retardation is assigned when an individual with subaverage intelligence deviates too far from the behavior standards dictated by societal norms. Thus, two people with the same IQ score and the same repertoire of adaptive competencies could presumably end up with different diagnostic outcomes with or without mental retardation if their environments produce different demands and behavioral expectations. In the earliest civilizations mental retardation was not differentiated from other handicapping conditions, and it was common for adults with mental retardation to be institutionalized with people with mental illness.
Both groups were believed to be insensitive to cold, heat, hunger, and pain, thus justifying the harsh treatment they often received in their confinement.
Mental Retardation: Struggle, Stigma, Science
Despite the fact that mental retardation was scientifically acknowledged in the early s to be an important social problem distinct from mental illness, many people today still do not recognize that the majority of persons with mental retardation are mentally healthy and are free of significant behavioral problems.
The distinction that eventually was made, to associate mental retardation with low intelligence and to associate mental illness with emotional disorders, has been identified as one explanation for current tendencies toward dismissing the possible presence of behavior disturbance among persons with mental retardation.
In other words, once it was clear that mental retardation was not synonymous with mental illness, the pendulum swung back such that these conditions were not even expected to co-occur. The term dual diagnosis is now applied to persons who have intellectual deficits mental retardation along with emotional impairment psychiatric disorders. As noted previously, people with mental retardation experience difficulty functioning independently in their environments but they do not necessarily have psychological disturbances.
When psychiatric disorders are present, they are usually of the same types and are diagnosed by the same criteria as for persons of normal intelligence. The dual diagnosis term grew out of the recognition that individuals with both conditions present unique needs to mental retardation and mental health service systems. Professionals have established the fact that the presence of these two conditions creates a complex set of issues that may complicate the diagnostic process and may require unique methods of treatment.
The utility of the dual diagnosis term has been questioned by some clinicians who believe it adds another stigmatizing label to persons who already experience difficulties obtaining services from agencies that resist taking responsibility for them. Others suggest this reflects problems with the service systems, rather than with labels or assessment per se.
Although mental retardation and psychopathology are believed to be functionally independent, studies of the prevalence of psychiatric disorders among individuals with mental retardation have shown, almost without exception, rates that are much higher than those found in the general population. Although the incidence of psychiatric disturbance has been found to be higher among persons with mental retardation, the literature consistently affirms that the majority of symptoms do not differ in kind from people without mental retardation who are referred for psychiatric evaluation.
Affective disorders, including depressive and bipolar disorders, have been found to occur with much greater frequency among children and adults with mental retardation than in the general population. Contrary to earlier hypotheses that people with mental retardation are devoid of feelings, the results of some studies suggest that adults with mild mental retardation appear to experience even higher rates of depression than their peers without mental retardation.
The symptoms of schizophrenia are generally similar across groups, although they may be simpler in form among persons with mental retardation. Anxiety disorders have received less attention than other psychiatric disturbances among persons with mental retardation. Although prevalence estimates are scarce, several authors have reported higher rates of anxiety among persons with mental retardation than in the general population.
A year longitudinal population study conducted in Aberdeen, Scotland, for example, found that more than one fourth of the children exhibited problems with nerves and anxiety by early adulthood. No differences were observed between boys and girls, but a higher prevalence was found among those with more severe levels of retardation. Studies have shown that persons with and without mental retardation experience the same types of fears. Several studies suggest that mental age is a factor in comparisons of fears across these groups, where fears of older people with mental retardation tend to be more similar to fears of younger nonretarded people.
Social phobias are expected to be high among persons with mental retardation; in the presence of cognitive limitations, social skill deficits are common and lead to increased vulnerability for peer rejection, low levels of social support, and social anxiety.
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An accurate count of individuals who have a dual diagnosis is dependent on valid and reliable assessments of both mental retardation and psychiatric disorder. Difficulties associated with obtaining valid estimates of adaptive behavior deficits have been noted since this criterion was first included in the definition of mental retardation. Prevalence studies have also been based on definitions of mental retardation that vary from the AAMR definition. Some widely cited studies e. Reliable diagnosis of mental health problems in persons with mental retardation also presents a major challenge to clinicians.
Identification of psychiatric disorders depends on the clinical method, the source of information, and the taxonomy of disorders used to assign diagnoses. Prevalence estimates are also affected by sampling bias. A large number of studies have been based on samples of individuals who have either been referred to clinics for psychiatric assessment or have resided in institutions where behavior problems led to their placement. Not surprisingly, these studies overestimate the presence of mental health problems among the population of persons with mental retardation.
Service system registries comprise another major sampling source, wherein individuals receiving state-funded services are included in databases containing records of client characteristics and services provided. Because people with mild mental retardation are less likely to require state services if they do not have serious health or behavior-related problems, these databases probably overestimate the prevalence of dual diagnoses among people with mild mental retardation in the population.
Finally, because many states have separate agencies providing services for persons with mental retardation and mental health problems, prevalence estimates may be affected by the determination of which agency tends to serve persons with both conditions. Although age has not been found to be related to the overall distribution of psychiatric impairment, studies of specific disorders suggest that some conditions may be age-related.
Moreover, in studies of behavior problems that have not been restricted to those with formal psychiatric diagnoses, age differences have been identified in rates of observed problem behavior in people with mental retardation, with lower rates found for children than for adolescents and adults. The relationship between the overall frequency of psychiatric disorder and severity of retardation has not been established; however, the available evidence suggests that specific types of psychiatric disorder appear to be more commonly found among certain levels of mental retardation.
Most studies show that the types of psychiatric syndromes observed among children and adults with mild or moderate levels of mental retardation are similar to those found in the general population, for example, major affective disorders; schizophrenia; obsessive-compulsive disorder; disorders of conduct; anxiety, activity levels, and attention; and mood and affect disorders. In contrast, some disorders are more commonly manifested by persons with severe levels of mental retardation, such as autism and other pervasive developmental disorders, aggression, stereotypic behaviors, and self-injurious behavior.
Stereotypy repetitive motor behaviors and self-injury may occur in isolation or in conjunction with major neuropsychiatric disorders among persons with severe or profound mental retardation. Most studies have found no significant relationships between overall behavior disturbance and gender. However, gender differences have been observed within certain types of disturbance. For example, consistent with findings in the nonretarded population, antisocial behavior has been found to be more prevalent among males, while emotional disturbance has been observed more frequently among females.
The evidence suggests that certain genetically related causes of mental retardation, such as Prader Willi syndrome, Cornelia de Lange syndrome, Lesch-Nyhan disease, fragile X syndrome, and Williams syndrome are associated with the presence of specific behavior problems and psychological disorders in persons with mental retardation. Lesch-Nyhan disease is best known for the manifestation of self-injurious biting.
The minority of individuals with Lesch-Nyhan who do not bite indulge in some other form of selfinjurious behavior, such as head banging. Aggressive behavior is also directed against others, and most of these individuals vomit, which interferes with nutrition. The majority of self-injuring individuals, however, have nonspecific diagnoses of mental retardation and display this behavior in self-stimulating or stereotypic patterns.
Fragile X syndrome is the most common known inherited cause of mental retardation and developmental disabilities.
Attention deficit disorders, autistic disorders, and socially related and anxiety-based disorders appear to be associated with fragile X syndrome, although these disorders are not present in all persons who have fragile X. Food preoccupation, hyperphagia, and obesity are most often associated with Prader Willi syndrome. Recent studies have also linked maladaptive symptoms that are not related to food, such as obsessive-compulsive disorder, temper tantrums, internalizing problems, and oppositional-defiant disorders to individuals with Prader Willi syndrome.
Intellectual Disability (Mental Retardation) | American Academy of Pediatrics
Recent data suggest increased risks of anxiety disorders and attention deficit hyperactivity disorder among people with Williams syndrome. Adults with Down syndrome appear to be at a higher risk of depression relative to other adults with mental retardation. Observed behavior problems do not by themselves indicate psychopathology. Interrelationships between deficits in adaptive behavior, maladaptive or problem behavior, and psychiatric disorders among persons with mental retardation are complex. Maladaptive behavior is a term that has been used in the field of mental retardation to refer to problem behaviors that are sometimes categorized as personal e.
In general, the terms maladaptive behavior and behavior problems are used interchangeably. Despite the definitional criteria that require deficits in adaptive skills to be present in persons with mental retardation, these deficits are not always associated with maladaptive behavior. Adaptive and maladaptive behavior represent two distinct, independent constructs and deficient interpersonal skill development i. Psychopathology is only indicated when behavior problems are part of an overall pattern of behavior. Although persons with a dual diagnosis are at a higher risk of evincing destructive behavior patterns e.
Although the diagnosis of mental retardation is determined in part by deficits in adaptive functioning, the behaviors that one must display in order to be considered competent cannot be clearly delineated for every situation and age group. Measures of social competence must, for practical reasons, sample only selected behaviors that are used to represent typical functioning.
Decisions that rely on measurement of adaptive and maladaptive behavior are highly dependent on the method of assessment used. Because base rates of behavior may be compared either to the general population or to the subset of people with mental retardation, the selection of a comparison group can also influence the identification of pathology. There is a general consensus that the full range of mental disorders observed in the general population is found among persons with mental retardation.
Early versions of the DSM classification system were thought to lack reliability and validity for persons with mental retardation, but the heightened awareness of dual diagnosis in the s led to vast improvements in defining DSM categories that were appropriate for persons with mental retardation.
Some clinicians still contend, however, that the expression of psychopathology among persons with severe and profound mental retardation may take on different forms and require separate classifications. Multiple informants and multiple methods of data collection are typically used to provide a clinical picture of abnormal behavior among persons with mental retardation.
Pediatric Intellectual Disability
Communication deficits that are associated with low intelligence complicate the evaluation process in several important ways. The simplistic emotional expressions and concrete thought patterns that are characteristic of these individuals can lead to clinical misinterpretations of their behavior or mental health conditions. The identification of some syndromes also depends on information obtained by interview with the individual or observation of his or her speech e.
With individuals who are nonverbal or who lack expressive language, it may be impossible to diagnose reliably certain conditions. Reprints and Permissions. Advanced search. Skip to main content. Rent or Buy article Get time limited or full article access on ReadCube. Rights and permissions Reprints and Permissions.
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