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;

 communication skills, such as understanding

what is said and being able to answer;

 social skills with peers, family members,

spouses, adults, and others.
Mental Retardation…
 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.

 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.

 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
.

 Diseases like measles, or meningitis can

cause mental disability if medical care is
delayed or inadequate.

 Exposure to poisons like lead or mercury may

also affect mental ability.
Causes for MR…

 Malnutrition is a common cause of reduced

intelligence

 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.

 The following ranges, based on Standard

Scores of intelligence tests, reflect the
categories of the Mental Retardation.
Diagnosis for MR…

Class IQ
Profound mental retardation Below 20
Severe mental retardation 20–34

Moderate mental retardation 35–49

Mild mental retardation 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.

 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.

 Children with moderate mental retardation will

require considerable supports in school, at home,
and in the community in order to participate fully.

 As adults they may live with their parents, in a

supportive group home, or even semi-
independently 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.

 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.

 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
 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

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

 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
 Rarely use gestures
 Rather than pointing they will get things for themselves
or take their mother’s hand and put it on the desired
object
 Some children cry inconsolably until the parent has
guessed on trial and error what the child wants
 Some children start to speak late they sing TV
commercials
CHARACTERISTIC
FEATURES…
Language difficulties
 Echolalia – repeating the question
 Use of “you” when they mean “I”

 Some verbal children with autism do not know how

to participate in conversation, maintain topic, take
turns, look at their conversational partner etc
 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

 Have difficulty in understanding other people’s thought

feelings and needs

 Can’t anticipate what one might think

 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
 Sight: Difficulty in height, width and depth
perception
 Tactile: avoids being hugged; preference to certain
texture/garments; likes deep massages
 Taste: is fussy about food
Intervention for Autism
 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…

 Dyslexia occurs in individuals with normal vision

and normal intelligence.

 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.

 They may have difficulty in comprehending

rapid instructions,

 Following more than one command at a time

or
Learning disability….
 Remembering the sequence of things

 Reversals of letters (b for d) and

 Reversal of words (saw for was) are typical

among individuals who have dyslexia.

 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,

 May not recognize the spacing that organizes

letters into separate words, and

 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.

• A child who functions two grades below his age

appropriate level with average intelligence can also be
considered to have specific learning disability.

• 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

 Take a moment between classes to ask about students and

demonstrate you care

 Allow students to participate in decision making regarding

class rules and management

 Identify youngsters who demonstrate un- involvement or

detachment and refer them to the counselor.

 Encourage students to participate in school related extra

curricular activities
AVOID…
 Do not use methods or techniques that were
ineffective previously

 Do not focus on emotionally loaded situations

 Do not create or maintain situations or conditions

that cause embarrassment

 Do not direct attention on what the student cannot

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

 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.

 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.

 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.

 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.

 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.

 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.

 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
 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…
 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.)

 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.
 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.
 Milder but prolonged depression can be
diagnosed as dysthymia.
 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.

 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.

 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…
 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…

 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.

 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.

 Psychosurgery is considered experimental but is

advocated by certain neurologists in certain rare
cases.

 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