Mental Retardation Educationally Sub Normal ESN Prof MOK

Mental Retardation (Educationally Sub Normal) ESN Prof. MOK Wahedi DCH(Hon, s)Ire, MRCP(UK), MRCPCH(UK), FRCP(Edin). Professor of Paediatrics William L. Heward Exceptional Children: An Introduction to Special Education , 8 e Copyright © 2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. 1

Mental Retardation Mental retardation is characterized by significantly sub-average general intellectual functioning, existing concurrently with deficits in adaptive behavior and manifested during the developmental period that adversely affects a child’s educational performance. 2

Definitions of Mental Retardation AAMR (92) Mental retardation (MR) refers to substantial limitations in present functioning. It is characterized by significantly subaverage intellectual functioning, existing concurrently with related limitations in two or more of the following applicable adaptive skill areas: 1. Communication 2. Self-Care 3. Home Living 4. Social Skills 5. Community Use 6. Self-Direction 7. Health And Safety 8. Functional Academics 9. Leisure And Work Mental retardation manifests before age 18. 3

Characteristics of students with MR Mild MR Usually not identified until school age Most students master many academic skills Most able to learn job skills well enough to support themselves independently or semi-independently Moderate MR Most show significant delays in development during the preschool years As they grow older the discrepancies in age related adaptive and intellectual skills widens Severe MR Usually identified at birth Most have significant central nervous system damage Likely to have health care problems that require intensive supports 4

Identification and Assessment Assessing Intellectual Functioning Standardized tests are used to assess intelligence A diagnosis of MR requires an IQ score at least 2 standard deviations below the mean (70 or less) Important considerations of IQ tests: IQ is a hypothetical construct IQ tests measure how a child performs at one point in time IQ tests can be culturally biased IQ scores can change significantly IQ testing is not an exact science Results are not useful for targeting educational objectives Results should never be used as the sole basis for making decisions regarding special education services 5

Normal Curve 6

Assessing Adaptive Behavior Adaptive behavior is the effectiveness or degree with which the individual meets the standards of personal independence and social responsibility expected of his age and social group Measurement of adaptive behavior has proven difficult because of the relative nature of social adjustment and competence 7

Prevalence and Causes Prevalence During the school year, approximately 1% of the total school enrollment receives special education services in the MR category Mild MR cases make up about 85% of all persons with MR Causes More than 750 causes of MR have been identified For approximately 50% of mild MR cases and 30% of severe MR, the cause is unknown 8

Causes Prenatal causes include: Chromosomal disorders Inborn errors of metabolism Developmental disorders Toxic exposure through maternal substance abuse Perinatal causes include: Intrauterine disorders Neonatal disorders Postnatal causes include: Head injuries Infections Degenerative disorders Malnutrition 9

Causes Prenatal (12%) occurs during fetal development Perinatal (6%) causes at birth postnatal (4%) occurring after birth, can be biological or psychosocial 78% unknown 10

Some Common Causes Perinatal anoxia, low birth weight, syphilis, herpes simplex Head trauma at birth Meningitis at birth prematurity 11

Some Common Causes. Postnatal TBI Meningitis Herpes simplex Encephalitis Lead intoxication Child abuse and neglect 12

Causes. Contd. Exposed to lead have a decrease of 2 -6 IQ points Head injuries from accidents, falls or child abuse ~50% of all postnatal causes Younger mothers with 12 years of education or less more likely to have children with MR 13

Down syndrome extra 21 st chromosome (Trisomy 21) not linked to heredity (MR, slanted eyes, single palm crease, hypotonia, shortness, obesity tendency) Fragile X Syndrome –(bottom of 23 rd is pinched off, can cause MR, more often males, thought to be most common hereditary cause of MR) Tay-Sachs Disease - a heritable metabolic disorder which leads to mental retardation, paralysis, dementia, or blindness. Both parents must be carriers. Williams syndrome - (deletion of materials in 7 th often cause mild to mod. MR heart defects, elfin facial, features, often display strengths in spoken language and very social deficits in special skills, reading, math, writing 14

Causes Prader-Willi syndrome from father’s side lack of material in 15 th pair degree of MR varies, most mild MR, obesity, Metabolism Phenylketonuria (PKU) Spina bifida Microcephalus, hydrocephalus, fetal alcohol syndrome, rubella, 15

Assessment Assess intellectual and adaptive skills Intellectual Professionally administered IQ tests Stanford-Binet Wechsler Intelligence Scale for Children (WISC-III) Kaufman Assessment Battery for Children (K-ABC) Includes observation, screening, and nondiscriminatory evaluation 16

Assessment & Support Determining nature and extent of services needed Frequency Daily support time Type of support Students with MR achieve high academic gains where they are more fully included in general classrooms Students with MR who were in general classroom full time were more socially competent and accepted than were students who were included in general classrooms only part time 17

Assessment & Support Academic gains are more positive when there is a greater degree of inclusion Age/grade of students appear to have more influence than extent of retardation in accounting for favorable inclusion outcomes. (Older experience more negative consequences from partial inclusion) Emphasize readiness skills for younger, and functional skills, community adjustment, and vocational training for older students 18

Educational Approaches Curriculum Goals Functional curriculum A functional curriculum will maximize a student’s independence, self-direction, and enjoyment in school, home, community, and work environments Life skills Skills that will help the student transition into adult life in the community Self-determination Self-determined learners set goals, plan and implement a course of action, evaluate their performance, and make adjustments in what they are doing to reach their goals 19

Characteristics of Effective Instruction Explicit and systematic instruction Task analysis Direct and frequent measurement of student performance Active student response Systematic feedback provided by the teacher Transfer of stimulus control from prompts to task Generalization and maintenance 20

Educational Placement Alternatives Some children with MR attend special schools Most are educated in their neighborhood schools Special classes Regular class with support Resource room The extent to which a student with MR should be included in the regular classroom should be determined by the student’s individual needs 21

Prevention Primary intervention before it occurs…(vaccines for rubella) Secondary intervention soon after detection (lead screening, PKU screening) Tertiary intervention to reduce long term effects (early education intervention) 22

The biggest single preventive strike against MR was the development of the rubella vaccine in 1962 Toxic exposure through maternal substance abuse and environmental pollutants are two major causes of preventable MR that can be combated with education and training Advances in medical science have enabled doctors to identify certain genetic influences Although early identification and intensive educational services to high-risk infants show promise, there is still no widely used technique to decrease the incidence of MR caused by psychosocial disadvantage 23

Prenatal Screening Amniocentesis (fluid) Chorionic villus sampling (CVS) (tissue) Sonography (visual) Maternal serum screening (MSS) (blood) 24

Current Issues and Future Trends Some concerns of the current definition of MR include: IQ testing will remain the primary means of assessment Adaptive skills cannot be reliably measured with current assessment methods The levels of need supports are too subjective Classification will remain essentially unchanged in practice Acceptance An especially important and continuing challenge is moving beyond the physical integration of persons with MR in society. 25