Intellectual disability: concepts and clinical perspectives

Mental Retardation

Students with a diagnosis of mental retardation present particular problems for teachers because their disability goes to the heart of what is supposed to happen at school. These students don't have the capacity to learn as easily or as completely as other students. However, in addition to difficulty with formal learning, the students must also show difficulties in every day functioning that are caused by lower intelligence.

Early Signs of Mental Retardation

Mild and moderate mental retardation can be difficult to detect in very early childhood. Children with mental retardation may have motor delays, but motor delays are often present in developmental problems that do not affect intelligence (Ammerman & Herson, 2000). As the child becomes a toddler, he or she may show language delays, but it is quite possible for a child with normal intelligence to have a language delay (Ammerman & Herson, 2000). As the child becomes older, however, other delays will become apparent, such as difficulty learning to recognize letters and behavioral immaturity. Because of the difficulty in diagnosing very young children accurately, children are often placed in early intervention programs without a final diagnosis having been made yet.

Causes

In most cases of mental retardation, some medical or genetic cause is clear. Down Syndrome, a genetic disorder, accounts for about 2/3 of those diagnosed with mental retardation (Turnbull et. al.). Down Syndrome is common, occurring in about 1 in every 1,000 live births (Ammerman & Herson, 2000). In another 25% of the cases, some abnormality in the nervous system is present (Ammerman & Herson, 2000). There is some evidence that the combination of low IQ combined with an environmental setting that does not support intellectual development can result in a child who ends up diagnosed as mildly retarded (Ammerman & Herson, 2000).

Assessment

While low IQ as measured on a good cognitive test is a cornerstone for the diagnosis of mental retardation, functional and adaptive skills must also be evaluated. A person who scores low on an IQ test but who functions adequately in life, for instance using public transportation, handling money adequately and living independently does not function as a retarded person and should not be diagnosed as such (Turnbull et. al.) (Ammerman & Herson, 2000). A medical evaluation can look at developmental milestone and rule out causes such as deafness. An educational evaluation should show that the student does not acquire new information as quickly as other students; struggles with retention and generalization; adaptive behaviors are behind same-aged peers (Turnbull et. al.).

Treatment

Treatment should involve helping the person with mental retardation gain basic academic skills that will support a functional life, such as reading, writing and arithmetic, development of appropriate social skills and behavior management techniques for any inappropriate behaviors. Behavior modification often works well to help shape desired behaviors (Ammerman & Herson, 2000).

Most experts today advocate early intervention, pointing to direct and indirect gains for the child's family as well as for the child. Experts report improved interactions with peers, support for the parents to act as teachers at home, improved motivation for the child, and aiding the family in learning about other support available in the community (Ammerman & Herson, 2000).

Medications may play a role if the child has other concerns such as AD/HD or seizures (Ammerman & Herson, 2000).

Inclusion with Mental Retardation

Educationally, some research suggests that students with mental retardation learn more in general education classes than in special education. Studies on inclusion aren't quite as clear. Students may benefit from inclusion when younger, but when older it may have more negative effects unless the non-handicapped students are supportive of the program (Turnbull et. al.). In addition to behavioral and socialization support, students need functional as well as academic skills. For instance, they should be taught how to use public transportation and information about handling money (Turnbull et. al.).

Inclusion will only be successful when teachers use strategies that facilitate the student's success. Often the emphasis is placed on behavioral interventions. Such interventions must both reduce inappropriate behaviors and teach more suitable behaviors to replace them (Ammerman & Herson, 2000). For example, a student who hugs others at inappropriate times can be taught to give "high fives" instead. One behavioral approach called "Positive behavior support, or PBS< has been shown to work well with this population (Swartz).

This approach looks at the environment and the skills set of the individual as well as the behavior itself (Swartz). It works on those issues along with the behavior, taking a long-term view of teaching appropriate behavior (Swartz).

If the environment supports inappropriate behavior, then the environment as well as the student must change. For instance, if the student laughs inappropriately and his or her peers respond with laughter, then the peers' response is part of the problem. The peers must be taught not to respond to inappropriate laughter (Swartz). Students with mental retardation need to be taught how to use self-determination skills. They have to be taught to set goals, to identify what they have to do to meet the goal, to identify obstacles, and to determine a way around those obstacles. Teaching students such things as behavior within the classroom context and setting goals helps normalize the student and supports inclusion.