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Mentally Handicapped

Mental retardation or mental disability is a disability , to varying degrees, of the intellect , faculties intellectual , the perception and behavior. It can be combined with other physical or mental disorder or occur in isolation ...

This disability of personality combines various aspects:

  • medical (genetic, infectious, poisoning, head injury, ...)
  • Social (our environment determines how to see disability in relation to the society in which we live)
  • cognitive (what is the IQ of the person?)
  • psychological (emotional development).

Summary

Terminology

The terms used to define persons with mental retardation have evolved over time. In the nineteenth century , people with moderate or severe retardation were classified as idiots or morons, while those who had a slight delay were called idiots or morons light. The Mongolian term, in connection with the physical characteristics associated with trisomy 21 , was also used until recently. Oligophrenia the term is used for a severe mental retardation.

There is still no clear consensus (or) term (s) to use, those of "mental retardation" and "mental disability" are added for example the terms "mental retardation" or of "intellectual disability". The World Health Organization still uses the term mental retardation English) Definition

The World Health Organization in its International Classification of Diseases (ICD-10), defines mental retardation as a developmental arrest mental or incomplete mental development characterized by impairment of skills and overall intelligence, particularly in terms of cognitive, language, motor skills and social abilities

.

Degrees

WHO distinguishes four degrees of delay:

  • the slight delay: IQ between 50 and 69, persons experiencing academic difficulties but able to integrate into society independently as adults,
  • average delay: IQ between 35 and 49, people familiar with childhood developmental delays important but good communication skills and a partial independence, with, as adults, need to support different levels to integrate society,
  • serious delay: IQ between 20 and 34, persons needing extended support,
  • delay profound: IQ below 20, people with little ability to communicate, move and take care of themselves.

The standard test to assess the IQ test Wechsler :

However, the scale Wechsler Adult (WAIS III for the latest version) does not measure an IQ below 45. IQ "normal" (statistical standard, 50% of the population) is between 90 and 109.

Prevalence

The rate of prevalence of mental retardation is approximately around 1 to 3% . This figure varies considerably across studies given the different definitions, different methods of assessment and different populations studied. It is estimated there are 1.6 boys to 1 girl (McLaren and Bryson, 1987)

Note that 85% of the population with disabilities has a mild intellectual disability, 10% had moderate disability, 3 to 4% a severe and 1-2% a profound deficiency.

Causes of mental retardation

The list of causes is important. But most often the cause remains unknown. His research often require several consultations to monitor the child and practice exams based on clinical findings.

Causes Frequency
Abnormal chromosome 4-28%
Dysmorphic syndromes 3-7%
Known genetic diseases 4-14%
Morphological abnormalities of the central nervous system 7-17%
Complications of prematurity 2-10%
Cultural-familial mental retardation 3-12%
Environmental factors and drug 5-13%
Causes endocrine 1-5%
Unknown 30-50%

About 30% of cases of mental retardation are due to prenatal factors (infections, alcohol consumption) and chromosomal disorders. 20% of cases are in turn linked to environmental factors (stimulation) while 15% is explained by perinatal conditions ( anoxia ) and postnatal (diseases). The heredity is involved in about 5% of cases. However, approximately 30% of diagnoses of mental retardation remain unknown cause (Morrison, 1995).

Genetic Conditions

Disorders transmitted from parent to child by genes at conception.

Fragile X Syndrome

This is the inherited cause of mental retardation the most frequent, related to the maturation of the FMR1 gene that plays an important role in brain development. The prevalence of this syndrome is approximately 1 in 4000 for men and 1 in 7,000 for women.

Other mental retardation X-linked

Mental retardation X-linked (called "RMLX) form a heterogeneous group of over 200 rare diseases have in common:

  • mental retardation of varying severity
  • with a hereditary risk of several people affected in one family, mostly men.

These delays are expressed in different ways and to varying degrees: language disorders, behavior, praxis, school problems, interpersonal, attention deficit ...

All symptoms that require appropriate educational programs and may be associated with other complications, epilepsy , hypotonia , laxity , etc..

Phenylketonuria

Hereditary syndrome that causes a disturbance of the metabolic amino acids, causing an accumulation of the enzyme phenylalanine hydroxylase, resulting in a loss of growth of brain development. However, mental retardation can be avoided if a proper diet is followed. The incidence is about 1 case per 15 000 births.

Tuberous Sclerosis

Disorder related to a problem of differentiation and migration of cells and, depending on the location of tubers, different aspects of human development will be achieved. Prevalence of about 1 in 12,000.

Lesch-Nyhan

Syndrome linked to dysfunctional metabolism purine which causes excessive production of uric acid. The prevalence is very low, about 1 in 100,000 births. Only boys are affected by this syndrome.

Prader-Willi

Disorder linked to chromosome 15, with a prevalence of about 1 in 15,000 births. This syndrome is divided into two phases. The first runs from birth until the second year, when the child eats very little and has trouble gaining weight. The second phase is instead characterized by a boundless appetite, resulting in morbid obesity and health problems. These people generally exhibit temper tantrums, obsessive-compulsive behavior, irritability, etc..

Angelman Syndrome

Also linked to chromosome 15, this syndrome has a prevalence of about 1 in 12,000. People with this syndrome have a developmental disability and a severe lack of expressive language. Some physical characteristics (long face, prominent jaw, teeth apart) and behavioral (inappropriate laughter, clapping) are linked to this syndrome.

Chromosome Disorders

Down Syndrome

This syndrome is also known under the term "trisomy 21". It is the cause of mental retardation with the highest prevalence, at about 1 birth of 770. It is however important to note that the probability of having a child with Down syndrome increases with maternal age. Thus, when the mother is aged 20-24, prevalence is about 1 in 1450 so that when the mother is aged over 40 years, the risk to spend approximately 1 in 100.

Problems in pregnancy

Development of the fetus affected by:

  • Infections or diseases contracted by the mother during pregnancy, especially during the first three months. The most damaging diseases are measles or rubella.
  • Toxins consumed by the mother (eg over-consumption of certain fish)
  • Consumption of certain drugs by the mother

Problems at birth

Some complications during childbirth can cause mental retardation:

  • Exposure to toxins or infections (eg genital herpes )
  • Trauma suffered by the baby (eg head injury due to excessive pressure)
  • Asphyxia (lack of oxygen, often due to the umbilical cord)

Environmental causes

Are factors that can be controlled by parents:

  • Nutrition
  • Sensory and physical stimulation
  • Physical and psychological safety
  • Drug and alcohol during pregnancy
  • Living environment (poverty)
  • Deficiency in iodine

Prevention

Primary prevention aims to prevent the onset of mental retardation. For example, the addition of iodine to food promotes healthy brain development. Also, the increase of folate in the diet during pregnancy may help prevent some birth defects. Advertising campaigns against drinking alcohol during pregnancy to prevent fetal alcohol syndrome are also a good example.

Secondary prevention involves intervention to reduce the harmful effects of certain risk factors, which could result in disability, as stimulation programs appropriate for certain types of autism.

Tertiary prevention aims to improve the functioning and quality of life of people with intellectual disabilities, to prevent the worsening of the impairment or development of other problems such as depression, for example. It also aims to facilitate the acquisition of skills and competencies in these individuals. The role of school psychologist can fit into this third type of prevention, for example, through programs or specialized work they carry out to improve the condition of the person with intellectual disabilities (Tasse & Morin, 2003 )

Support and advice

There are various organizations and associations that offers consulting and coaching in addition to campaign with their respective governments to promote academic and social integration of people with intellectual disabilities.

Education for children with mental retardation

Classification

Classification by the Ministry of Education, Recreation and Sports in Quebec

Since the update of its special education policy, the MELS (2000) defines two categories of students in special education. Since this update, students with mental retardation were divided into two categories, the category of "disabled students" includes students with mental retardation to low functioning (medium to deep), while students with a delay mild mental are considered "at-risk students." MELS classification reflects the complexity of the universe of students with mental retardation. This distribution of at-risk students and students classified as disabled stresses the importance of distinguishing between students with mild intellectual disabilities, who are more numerous, those with more severe disabilities so that we can respond appropriate to the particularities of each.

MELS defines its categories of disabled students, students with moderate mental retardation, indicating that these students, in addition to providing intellectual limitations, also have specific characteristics, as difficulties in terms of sensorimotor and language. These students need assistance in organizing activities and need guidance in terms of personal and social autonomy. The definition indicates that the MELS student with a disability because of moderate to severe intellectual disability has an overall operation that is significantly lower than the average (IQ, which is between 20-25 and 50-55) and well as impaired adaptive behavior appearing early in the growing season.

Student Evaluation handicapped by mental retardation

Evaluation by Department of Education, Recreation and Sports in Quebec

The assessment addresses two very distinct functions. First, it has a diagnostic feature for identification of a student who is necessary for its administrative declaration. The diagnosis can be made by a professional, but does not automatically administrative declaration. It is the responsibility of the principal is not obliged to declare a student with intellectual disabilities. Then, the evaluation function needs analysis for the development or revision of the intervention plan of the student. It is then to assess the needs, strengths and weaknesses of the student. These estimates update may consist of interviews, observations and testing for various paint a picture of current student needs. These assessments updated less time than the diagnostic evaluation.

Intellectual functioning of a student is usually assessed by intelligence tests or developmental scales standardized, validated and standardized. The results of these instruments are in IQ or development quotient. The level of adaptive functioning, in turn, can be assessed by measuring instruments such as scales of adaptive behavior standardized, validated and standardized or a clinical evaluation report.

The prevalence of autism and pervasive developmental disorders

Over the past decades, autism and other pervasive developmental disorders have been a significant increase in North America and Europe (Wing & Potter, 2002). Nevertheless, the prevalence of pervasive developmental disorders remains rather low, it is estimated at 21 cases per 10 000 population (Wing & Potter, 2002), four times more boys than girls (American Psychiatric Association, 2003). Indeed, between 1998 and 2004 the number of children diagnosed with pervasive developmental disorder (PDD) enrolled at the school board in Montreal has increased by 337% (Commission Scolaire de Montreal, 2004).

What are the possible reasons for this dramatic increase? According to Wing and Potter (2002) a number of reasons explain the increasing prevalence of students with ASD. First, due to methodological disparity of prevalence studies (eg, different criteria or diagnostic tools used in study), it is difficult to assess the actual increase in this population (see also Fombonne, 2003). Changes in diagnostic criteria also have influenced this increase, they have become more inclusive. Since its appearance in the Diagnostic and Statistical Manual (DSM-III, American Psychiatric Association, 1980), diagnostic criteria and categories have changed. Certain categories of childhood disorders have disappeared and others have emerged (eg the addition of pervasive developmental disorder not specified). The introduction of the concept of autism as part of a continuum have also created a change in the detection of PDD. Other factors are also likely to have influenced this increase, including an awareness of the general public and professionals as well as stakeholders with pervasive developmental disorders. Finally, opening specialized services for these students may have also contributed to increased diagnosis (Roux, Leroux and Dion, 2005).

Development of the characteristics of autism from childhood to adolescence

The majority of people diagnosed with autism or pervasive developmental disorder in childhood remain affected throughout their lives, which also applies to high functioning autism or people being affected by a syndrome Asperger's (Seltzer et al. 2004; Piven et al., 1996). The symptoms of autism manifest themselves differently elsewhere in the development of the person (Seltzer et al. 2003; Wing, 1996, Piven 1996). Heterogeneity in growth characteristics is also observed among individuals with autism. While some people lose skills over time, others have reached a plateau in adolescence, so that is noticed in some steady improvement. For those with more advanced, the difficulties in adolescence are similar to those of young people are not suffering from a particular deficit (Wing, 1996).

Several retrospective studies or longitudinal showed a significant improvement in communication from childhood to adolescence (Piven et al. 1996; Nordin and Gillberg, 1998, Seltzer et al., 2003). Seltzer et al. (2003) also note that these are grammatical errors in the speech of the person down, while no change is observed in the use of gestures to communicate. Language skills in childhood can predict better psychosocial adjustment in adolescence and adulthood (Venter, 1992). The area that shows the least progress is repetitive and stereotyped behaviors (Piven et al. 1996; Seltzer et al., 2003). Venter et al. (1992) showed that although adaptive behavior deficits persist into adolescence and adulthood, the intelligence quotient of their subjects had increased 10 points.

Some will sink, in adolescence, a period of inactivity, characterized by a loss of interest and difficulties in engaging in motor activities and new hobbies (Wing, 1996, Nordin and Gillberg, 1998). Ghaziuddin et al. (2002) suggest that the deterioration of behavior observed in some adolescents would cause depressive episodes. They also occur with greater understanding of social problems and are more prevalent among those with better cognitive skills (Nordin and Gillberg, 1998; Roge, 2003). The difficulty to establish relations of friendship is indeed a problem that persists throughout the life of the individual with autism (Seltzer, 2004, Fullerton, 1996; Wing, 1996).

Evaluation of the student with a pervasive developmental disorder

In Quebec's educational system, students with pervasive developmental disorder has been diagnosed are assigned code 50. The diagnosis must be made by a psychiatrist or child psychiatrist (MEQ, 2000). By cons, several months may pass before a child suspected of having a pervasive developmental disorder meets a psychiatrist or child psychiatrist. Thus, many school boards consider the clinical opinion of the school psychologist to assign code 50 to the child pending the medical diagnosis, so it is able to receive appropriate services in a suitable period of time.

The school psychologist has no medical or biological marker with which to assess the presence of a pervasive developmental disorder. It therefore falls to observe the natural child or structured using a grid provided for this purpose. It may also use certain tests available. However, scores on these tests do not suggest a pervasive unequivocally.

Integration of school students with pervasive developmental disorder

The integration of the child with an autism spectrum disorder (ASD) in mainstream schools is an area little studied (Poirier, Paquet, Giroux and Forget, 2005). However, the deficits involved in the achievement of a syndrome such as autism pose particular challenges to school integration. Restricted social relations, restrictions on the level of verbal behavior, stereotyped behavior and sometimes even aggressive, intellectual functioning particular, attention span, poor generalization of learning and dependence on primary reinforcing stimuli raise some difficulties during the enrollment of students in regular classes TED. However, integration is a service for students with ASD so they can receive quality education in a context as normal as possible and thereby establish contacts with non-disabled peers. All these children do not receive this service. To gain access, under section 235 of the Act on Public Education, the candidate must first demonstrate the feasibility of this integration and demonstrate that there will be no "undue hardship" law other children (Snchal, 2002). Also, placement of students with autism is primarily a decision of school authorities, parents' opinions is not a priority in decisions about the choice of educational environment for their child (Court, Supreme Court of Canada, 1997; Paquet, 2006).

In 12 years (1990-1991 to 2002-2003), the number of students with difficulty code 50 has increased by 495% in Quebec and represented 10% of the number of students identified as disabled (Pack, 2006 ). The survey Package (2006), with 110 students with pervasive developmental disorder, found that in Quebec, 60.9% of these students attend mainstream schools while 38.2% attend special schools. Those who are educated in a mainstream school, only 36.4% are placed in regular classes and most of them receive an escort service. Still according to this survey, the psychologist provides professional services for 37.3% of students with ASD at primary and secondary for 32.1%.

Some authors (Grubar, Martinet, Muh and Roger, 1994; Laushey and Heflin, 2000, Poirier et al., 2005) reported that several prerequisites are necessary to integrate autistic people, otherwise there is a risk of exclusion. The social integration of children with ASD among peers and the teacher of the reception class is in others, in connection with the ability to maintain and initiate social interaction, imitation, attention, IQ and level of communication (Garfinkle and Swartz, 2002, Harris and Handleman, 2000; Kennedy and Itkonen, 2001; Rivard Paquet and Forget, 2005; Sigman and Capps, 1997, Sigman and Ruskin, 1999 ; Simpson, Boer-Ott & Smith-Myles, 2003). Also, certain conditions are likely to be met to increase the likelihood of success of school integration of students TED, including adaptation of curriculum, training of teachers in the reception class, the preparation for integration with a program of intensive early intervention, the presence of a measure of support and parental involvement (Poirier et al., 2005).

Strategies for Inclusive Education

Notes

  1. a and b (in) International Classification of Diseases on the site of the WHO
  2. (en) Translation of the International Classification of Diseases on the site of the University of Rennes 1
  3. David Wechsler, The Measurement of Adult Intelligence (1944), Baltimore, The Williams & Wilkins Company
  4. Chelly J, Khelfaoui M, Francis F, Cherif B, Bienvenu T, Genetics and pathophysiology of mental retardation , Eur J Hum Genet 2006; 14:701-713

References

  • American Association on Mental Retardation. "Mental Retardation. Definition, Classification, and Systems of Support, 10th Edition" (2002). Washington, DC, AAMR.
  • DSM-IV-TR (2003) Diagnostic and Statistical Manual of Mental Disorders, Text Revision, Masson
  • Kaufman, Alan S. & Lichtenberger, Elizabeth O. "Assessing Adolescent and Adult Intelligence" (2002), Boston, Allyn & Bacon.
  • Tass, MJ, Morin, D. (2003) La dficience intellectuelle. Quebec. Gatan Morin dition.
  • Curry CJC, Stevenson RE, Aughton D, Byrne J, Carey JC, Cassidy S, Cunniff C, Graham JM Jr., Jones MC, Kaback MM, Moeschler J, Schaefer B, Schwartz S, Tarleton J, Opitz J Evaluation of mental retardation: Recommendations of a consensus conference Am J Med Genet 72:468-477

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