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What is implied when a child is mentally retarded
An IQ and adaptive behavior score < 70
What is the cause of most incidences of moderate, sever and profound mental retardation
Most children with moderate, severe and profound mental retardation have a known cause such as Downs (moderate) or intractable seizures and microcephaly (severe)
What is the cause of mild mental retardation
In most cases, there is no known cause
What type of mental retardation occurs with fetal alcohol syndrome
Mild mental retardation
Explain expected IQs in the mentally retarded population.
- IQ and adaptive behavior score < 70
- Mild MR - 50-70
- Moderate MR - 50-35
- Severe 35-20
- Profound <20
What is the incidence of mental retardation in children?
Which type is most common MR in the general population?
Which type is most common in children with other developmental issues like Down syndrome?
What are the available services for MR
- Medical evaluations and medical treatment. -May need genetic services, hearing and ophthalmology services.
- Early intervention services
- Special education
- Appropriate therapies –speech therapy, occupational therapy, and physical therapy Vocational rehabilitation services
- CAPS and other home-based services
How are children with mental retardation evaluated?
- Usually conducted in evaluation centers or school
- psychologists usually do the testing but educational specialists or therapists may do it
If a child is diagnosed with mental retardation what will occur
A specialized plan
What type of plan does a young child receive when they have MR
Individualized Family service plan
What type of plan does a school aged receive when they have MR
What type of plan does an adult receive when they have MR
They get a similar plan as children or school aged kids
Who designs special plans for children with MR
They are designed by the responsible social agency together with the family and they must be updated regularly
What should be in the specialized plan
- Information about preschool or classroom placement
- Goals for each subject area especially language arts and math.
- Therapies including the amount of time per week.
- Adaptations such as special computers.
What is typically missing from an IEP?
- In North Carolina the medical community is often separate from the schools, etc. and this can cause some problems because these same children often need medical work-ups for genetic diseases, metabolic diseases, or behavioral problems.
- Typically, the physicians have to connect with the schools to make sure that appropriate services are in place - they may recommend more thorough evaluations
How do watchdog groups help children get served
- they help children get services that they need
- Duke has a special ed clinic that does this
What is adaptive behavior testing
- They test everyday behavior such as dressing
- to qualify as MR, <70
What is a learning disability?
- Difficulty with one or more areas of processing
- IQ is average but academic range is below average
What are the most common areas of learning disabilities
- Written language most common problem; reading is the second most common problem; math problems are not as common.
- This is different from children with mental retardation or autism.
Would a sensory impaired child have a learning or intellectual disability
- Ex: deaf or blind
What is the incidence of learning disabilities
What is the difference between intellectual and learning disabiltiy
- Intellectual - processing problems
- Learning-normal IQ and adaptive bahavior, no physical disabilities
What are the areas of processing evaluated for learning diabilities
- Visual processing
- auditory processing
- fine motor
- social skills
- written language
How should a child with suspected mental retardation be evaluated?
- IQ testing –verbal versus performance IQ is often assessed.
- Achievement testing –reading, math, written language in particular.
- Comparison of discrepancies.
- Additional testing may include speech and language testing, or occupational therapy testing.
After evaluation what scores indicate a learning disabilities
- Discrepancies in scores result in services in North Carolina public schools
- Need 20 point discrepancy between verbal and performance IQ
- Need 15 point discrepancy between IQ and subject area.
What services are available for learning disabilities
- special education services in a resource class.
- the majority of classes are in the regular classroom.
- specific therapies like speech therapy.
- Individualized Education Plan.
- Children with just ADHD can get a 504 plan.
- Some children can be labeled OHI.
- May get up to three hours per day in special education classes.
- Some children are in self-contained special education but can go to some regular classes.
- Some schools have special classrooms that are essentially regular classrooms but have a second special education
- teacher in the classroom to help the students with special needs.
What are the 3 main areas of deficiency in autism
- Speech and language delays or deficiencies. Some affected individuals are nonverbal.
- Social skills are abnormal. Relate poorly to people. May make poor eye contact. May talk about bizarre topics.
- Repetitive or ritualistic behaviors. May be obsessed with weather, may have odd gestures.
Why is there a huge increase in autism
Part of the increase in frequency may be due to the increase in services available to autistic children (parents want the dx) but this doesnt totally explain the huge increase
What is the incidence of autism
1 in 150
Who gets autism more
How many autistic children are classified as MR
- This is lower that what it used be
How are seizures r/t autism
20% of adolescents with autism have seizures
What are different types of autism?
- Hugh functioning
- Aspergers Syndrome
- Pervasive development disorder
What is infantile autism
Classical autism may be mild, moderate or severe
What is high functioning autism
May not be intellecutually disabled or mentally retarded
What is Aspergers Syndrome
Good cognitive ability and good language but still have preoccupations and social problems
What is pervasive development disorder
On the spectrum but fails to meet all criteria for autism
Which type of autism is most common in society
High functioning autism
How is autism diagnosed
- Usually DSM IV is used
- congnitive testing is done but not tested by area rather than just IQ - testing in fine motor domain, language domain, ect
- often children with autism have average gross and fine motor but poor verbal and social skills
What is the medical evaluation for autism
- Genetic and metabolic work up - chromosome and fragile X are usually done because many of these disorders have high number of autism
- MRI is normal so usually not done unless very low functioning
- EEG - may be necessary to rule out seizures
- Medications - often used for hyperactivity, OCD, anxiety, depression **children aren't great medication responders**
- Often have problems sleeping
What services are available for autistic children
- Special education - Classrooms appeal to visual strengths and motor strengths.
- Children may have pictures that outline their day. Structure is very emphasized.
- Speech and language therapy
- Occupational therapy
- Social skills groups
What are the most common causes of mental retardation
What is the incidence of downs syndrome
1 in 700 births
Absence of chromosome X
Expansion of genetic material on the X chromosome
Fragile X syndrome
What is the most common cause of inherited mental retardation, learning disabilities, and autism
What is fragile X
- the most common cause of inherited mental retardation, learning disabilities, and autism.
- X-linked disorder
- Males more severely affected than females
- This is the single one thing to look for in autism
Other than the typical chromosomal abnormalities (Trisomy 18,21, turners, ect) what can cause abnormalties
Insertions or deletions
What should be considered on any child with MR dysmorphic physical features
Chromosomal work up should be considered
When do children with chromosomal abnormalities get diagnosed
In the newborn nursery which qualifies them for a full range of early intervention services
What is WIlliams Syndrome
- 7q11.23 deletion
- 16 deleted genes identified to date
- causes mental retardation, small stature, and heart disease
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