Mr, Autism, Ld & Mi: An Overview

Mental Retardation & Mental Illness - An Overview S. Karthikeyan Clinical Psychologist NIEPMD

Mental Retardation 

Mental retardation is a condition, characterized by sub-average cognitive functioning and deficits in two or more adaptive behaviors with onset before the age of 18.

Mental Retardation… 

Adaptive behavior, or adaptive functioning, refers to the skills needed to live independently (or at the minimally acceptable level for age).

Mental Retardation… adaptive behavior, such as: 

daily living skills, such as getting dressed, using the bathroom, and feeding oneself;

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communication skills, such as understanding what is said and being able to answer;

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social skills with peers, family members, spouses, adults, and others.

Mental Retardation…     

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Delays in oral language development Deficits in memory skills Difficulty in learning social rules Difficulty with problem solving skills Delays in the development of adaptive behaviors such as self-help or self-care skills Lack of social inhibitions

Causes for MR 

Genetic conditions. Sometimes disability is caused by abnormal genes inherited from parents, errors when genes combine, or other reasons.

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The most prevalent genetic conditions include Down syndrome, Klinefelter's syndrome, Fragile X syndrome, Neurofibromatosis, Congenital hypothyroidism, Williams syndrome, Phenylketonuria (PKU), and Prader-Willi syndrome.

Causes for MR… 

Problems during pregnancy. Mental disability can result when the fetus does not develop properly.

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For example, there may be a problem with the way the fetus' cells divide as it grows. A woman who drinks alcohol or gets an infection like rubella during pregnancy may also have a baby with mental disability.

Causes for MR… 

Problems at birth. If a baby has problems during labor and birth, such as not getting enough oxygen, he or she may have developmental disability due to brain damage.

Causes for MR… 

Exposure to certain types of disease or toxins .

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Diseases like measles, or meningitis can cause mental disability if medical care is delayed or inadequate.

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Exposure to poisons like lead or mercury may also affect mental ability.

Causes for MR… 

Malnutrition is a common cause of reduced intelligence

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Iodine deficiency, affecting approximately 2 billion people worldwide, is the leading preventable cause of mental disability

Diagnosis for MR Three criteria must be met for a diagnosis of mental retardation:  an IQ below 70,  significant limitations in two or more areas of adaptive behavior (as measured by an adaptive behavior rating scale, i.e. communication, self-help skills, interpersonal skills, and more), and  evidence that the limitations became apparent before the age of 18.

Diagnosis for MR 

It is formally diagnosed by professional assessment of intelligence and adaptive behavior.

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The following ranges, based on Standard Scores of intelligence tests, reflect the categories of the Mental Retardation.

Diagnosis for MR… Class Profound mental retardation Severe mental retardation

IQ Below 20 20–34

Moderate mental retardation Mild mental retardation

35–49 50–69

Borderline intellectual functioning

70–79

Characteristics in MR 

In early childhood mild mental retardation (IQ 50–70) may not be obvious, and may not be identified until children begin school.

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As individuals with mild mental retardation may reach adulthood, many learn to live independently and maintain gainful employment.

Characteristics in MR… 

Moderate mental retardation (IQ 35–49) is nearly always apparent within the first years of life.

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Children with moderate mental retardation will require considerable supports in school, at home, and in the community in order to participate fully.

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As adults they may live with their parents, in a supportive group home, or even semiindependently with significant supportive services to help them

Characteristics in MR… 

A person with severe and profound mental retardation will need more intensive support and supervision for his or her entire life.

Treatment for MR 

By most definitions mental retardation is more accurately considered a disability rather than a disease.

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Currently, there is " no cure" for an established disability, though with appropriate support and teaching, most individuals can learn to do many things.

Treatment for MR… 

Although there is no specific medication for mental retardation, many people have further medical complications and may take several medications.

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Beyond that there are specific programs that people can take part in wherein they learn basic life skills. These "goals" may take a much longer amount of time for them to accomplish, but the ultimate goal is independence.

Treatment for MR… 

People with developmental disabilities learn throughout their lives and can obtain many new skills even late in life with the help of their families, caregivers, clinicians and the people who coordinate the efforts of all of these people

AUTISM SPECTRUM DISORDERS

Autism 

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A condition of uneven skill development primarily affecting the communication and social abilities of a person, marked by repetitive and ritualistic behavior

Children with autism spectrum disorders mostly have a general appearance, leading to challenge in early diagnosis and in effective management during their early developmental period

PREVELANCE 

10 in 10,000 births

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Male – Female Ratio is 4:1

ASD TYPES     

Autism Rett’s Syndrome Childhood Disintegrative Disorder Asperger’s PDD Not Otherwise Specified

Autism Spectrum Disorders 

Autism is part of a the broad group of disorders known as pervasive developmental disorders

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Rett’s Disorder normal development for 5 months to 4 years, followed by regression and mental retardation,

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Childhood Disintegrative Disorder, normal development for at least 2 and to 10 years, followed by significant loss of skills

Autism Spectrum Disorders… 

Asperger’s Syndrome,or Asperger’s Disorder much like mild autism but usually without significant delays in cognition and language.

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Pervasive Developmental Disorder not Otherwise Specified. Pervasive delays in development that does not fit into any other diagnostic categories

Signs and symptoms        

Language comprehension difficulties. Repetition of words (echolalia) Unable to react or express emotions Self harming (hitting, biting, banging) Poor eye contact Delayed / limited speech Possession conflict (“my toy”) Seem to act like they are deaf even though nothing is wrong with their hearing.

CHARACTERISTIC FEATURES Language difficulties 

Unable to communicate verbally

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Rarely use gestures

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Rather than pointing they will get things for themselves or take their mother’s hand and put it on the desired object

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Some children cry inconsolably until the parent has guessed on trial and error what the child wants

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Some children start to speak late they sing TV commercials

CHARACTERISTIC FEATURES… Language difficulties 

Echolalia – repeating the question

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Use of “you” when they mean “I”

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Some verbal children with autism do not know how to participate in conversation, maintain topic, take turns, look at their conversational partner etc

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The tone of voice is different either high tone or sing-song or flat robot like, they speak in a monotone or too softly

CHARACTERISTIC FEATURES… Thought difficulties 

Attachment to object rather than humans

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Have difficulty in understanding other people’s thought feelings and needs

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Can’t anticipate what one might think

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For unexplained reasons, people with autism demand consistency in their environment.

CHARACTERISTIC FEATURES… Sensory difficulties 

Hearing: every day sounds may be painful; unable to filter out unwanted sounds

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Sight: Difficulty in height, width and depth perception

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Tactile: avoids being hugged; preference to certain texture/garments; likes deep massages

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Taste: is fussy about food

Intervention for Autism  

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Applied Behavior analysis-ABA. Alternative Augmentative and Communication system-AAC. Calendar System. Picture exchange communication system- PECS. Treatment and Education of Autistic and related Communication Handicapped Children- TEACCH. Sensory Diet program. Sensory Integration techniques

“Persons with mental retardation / developmental disabilities cannot be cured but only be rehabilitated”

Learning Disability

Learning disability 

Also known as Dyslexia…

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Dyslexia occurs in individuals with normal vision and normal intelligence.

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Such individuals usually have normal speech but often have difficulty in interpreting spoken language and writing.

Learning disability… Individuals with dyslexia commonly have problems in 

Processing and understanding what they hear.

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They may have difficulty in comprehending rapid instructions,

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Following more than one command at a time or

Learning disability…. 

Remembering the sequence of things

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Reversals of letters (b for d) and

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Reversal of words (saw for was) are typical among individuals who have dyslexia.

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Individuals with dyslexia may also try to read from right to left,

Learning disability… 

May fail to see (and occasionally to hear) similarities and differences in letters and words,

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May not recognize the spacing that organizes letters into separate words, and

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May be unable to sound out the pronunciation of an unfamiliar word.

Indications of L D… •

Academic failure in a normal intelligent child would indicate the existence of learning disability.

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A child who functions two grades below his age appropriate level with average intelligence can also be considered to have specific learning disability.

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Other areas of assessment may include perception, cognition, memory, attention, and language abilities.

WHAT CAN TEACHERS DO…. 

Try for a small class size that encourage all students to participate

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Take a moment between classes to ask about students and demonstrate you care

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Allow students to participate in decision making regarding class rules and management

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Identify youngsters who demonstrate un- involvement or detachment and refer them to the counselor.

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Encourage students to participate in school related extra curricular activities

AVOID… 

Do not use methods or techniques that were ineffective previously

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Do not focus on emotionally loaded situations

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Do not create or maintain situations or conditions that cause embarrassment

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Do not direct attention on what the student cannot do

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Each student is unique. One differs from another intellectually, emotionally, socially & physically.

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Special needs of the students must be met with additional inputs from outside the regular class room.

Mental Illness

Mental Illness 

mental illness is a psychological or behavioral pattern that disrupt a person’s thinking, feeling, behavior, ability to relate to others and daily functioning.

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mental illnesses is a condition that often results in a diminished capacity for coping with the ordinary demands of life

Facts About Mental Illness 

Mental illnesses can affect persons of any age, race, religion or income.

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The World Health Organization estimates that, by 2020, depression will be the leading cause of disability in the world for women and children.

Facts About Mental Illness… 

One in four adults has a diagnosable psychiatric illness. One in ten children suffers from a psychiatric illness.

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Mental illnesses usually strike individuals in the prime of their lives, often during adolescence and young adulthood. All ages are susceptible, but the young and the old are especially vulnerable.

Causes - Biological Factors 

Genetics (heredity): Many mental illnesses run in families, suggesting that people who have a family member with a mental illness are more likely to develop a mental illness.

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Infections: Certain infections have been linked to brain damage and the development of mental illness or the worsening of its symptoms. Ex: pediatric autoimmune neuropsychiatric disorder (PANDA)

Causes - Biological Factors… 

Brain defects or injury: Defects in or injury to certain areas of the brain have also been linked to some mental illnesses.

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Prenatal damage: Some evidence suggests that a disruption of early fetal brain development or trauma that occurs at the time of birth

Causes - Biological Factors… 

Substance abuse: Long-term substance abuse, in particular, has been linked to anxiety, depression, and paranoia.

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Other factors: Poor nutrition and exposure to toxins, such as lead, may play a role in the development of mental illnesses.

Causes – Psycho-Social Factors 

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Severe psychological trauma suffered as a child, such as emotional, physical, or sexual abuse An important early loss, such as the loss of a parent Death of a loved one Neglect Poor ability to relate to others

Causes – Psycho-Social Factors…    

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Divorce / Failure in affairs A dysfunctional family life Living in poverty Feelings of inadequacy, low self-esteem, anxiety, anger, or loneliness Changing jobs or schools

Causes – Psycho-Social Factors… 

Social or cultural expectations (For example, a society that associates beauty with thinness can be a factor in the development of eating disorders.)

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Substance abuse by the person or the person's parents

Mental Illness - Types 

The state of anxiety or fear can become disordered, so that it is unusually intense or generalized over a prolonged period of time.

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Commonly recognized categories of anxiety disorders include      

Specific phobia Generalized anxiety disorder Social Anxiety Disorder Panic Disorder Obsessive-Compulsive Disorder Post-traumatic stress disorder

Mental Illness – Types… 

Mood disorder involving unusually intense and sustained sadness or despair is know as Major depression.

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Milder but prolonged depression can be diagnosed as dysthymia.

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Bipolar disorder involves abnormally "high" or pressured mood states, known as mania or hypomania, alternating with normal or depressed mood.

Mental Illness – Types… 

Psychotic disorders centrally involving this domain include Schizophrenia, and Delusional disorder.

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Schizoaffective disorder is a category used for individuals showing aspects of both schizophrenia and affective disorders.

Mental Illness – Types… 

The fundamental characteristics of a person that influence his or her cognitions, motivations, and behaviors across situations and time - can be seen as disordered due to being abnormally rigid and maladaptive.

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Categorical schemes list a number of different personality disorders, such as those classed as eccentric those described as dramatic or emotional

Symptoms In adults  Confused thinking  Long-lasting sadness or irritability  Extreme highs and lows in mood  Excessive fear, worry, or anxiety  Social withdrawal  Dramatic changes in eating or sleeping habits  Strong feelings of anger

Symptoms… 

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Delusions or hallucinations (seeing or hearing things that are not really there) Increasing inability to cope with daily problems and activities Thoughts of suicide Denial of obvious problems Many unexplained physical problems Abuse of drugs and/or alcohol

Symptoms… In older children and pre-teens  Abuse of drugs and/or alcohol  Inability to cope with daily problems and activities  Changes in sleeping and/or eating habits  Excessive complaints of physical problems  Defying authority, skipping school, stealing, or damaging property

Symptoms…  

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Intense fear of gaining weight Long-lasting negative mood, often along with poor appetite and thoughts of death Frequent outbursts of anger

Symptoms… In younger children  Changes in school performance  Poor grades despite strong efforts  Excessive worry or anxiety  Hyperactivity  Persistent nightmares  Persistent disobedience and/or aggressive behavior  Frequent temper tantrums

Psychotherapy There are several main types.  Cognitive behavioral therapy (CBT) is widely used and is based on modifying the patterns of thought and behavior associated with a particular disorder. 

Psychoanalysis, addressing underlying psychic conflicts and defenses, has been a dominant school of psychotherapy and is still in use.

Psychotherapy… 

Systemic therapy or family therapy is sometimes used, addressing a network of significant others as well as an individual. Some psychotherapies are based on a humanistic approach.

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Psycho-education may be used to provide people with the information to understand and manage their problems.

Psychotherapy… 

Creative therapies are sometimes used, including music therapy, art therapy or drama therapy. Lifestyle adjustments and supportive measures are often used, including peer support, self-help groups for mental health and supported housing or supported employment (including social firms). Some advocate dietary supplements.

Psychotherapy… 

Electroconvulsive therapy (ECT) is sometimes used in severe cases when other interventions for severe intractable depression have failed.

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Psychosurgery is considered experimental but is advocated by certain neurologists in certain rare cases.

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Many things have been found to help at least some people. A placebo effect may play a role in any intervention.

Associated Conditions   

ADHD Emotional Disorders Childhood Psychiatric Disorders

“when dealing with people, let us remember that we are not dealing with creatures of logic. We are dealing with creatures of Emotions, creatures with Prejudices and motivated by Pride and Vanity” - Dale Carnegie