Caregiving

Mental Retardation

• Significant subaverage general intellectual functioning which is defined as two standard deviation
below to mean on an individual test of intelligence
• Adaptive skill deficits which are defined as significant limitations on a person’s ability to exhibit self-
care, home living, social skills, community use, self-direction, health and safety, functional
academics, leisure, and work skills
• The age of onset refers to a time interval specifying that the disability must occur prior to 18 years
of age

Classification – to provide a frame of reference for studying, understanding, and providing supports and
services for people with mental retardation

• Severity may be discussed in the terms of mild, moderate, severe, or profound retardation
▪ Use of scores on intelligence tests
▪ Indicators of adaptive behavior
• Educability expectations are:
▪ Borderline – (IQ 70 to 84)
▪ Mild – Educable (IQ 55 – 69)
▪ Moderate – Trainable (IQ 40 – 54)
▪ Severe – Custodial (IQ 40 – 20)
▪ Profound (IQ below 20)

Educable

• Second to fifth grade achievement in academic areas

• Social adjustment will permit some degree of independence in the community
• Occupational sufficiency with permit partial or total self-support

Trainable

• Learning is primarily in the area od self-help skills

• Some achievement occurs in academic areas
• Social adjustment is often limited to the home and nearby area
• Employment opportunities often include supported work in a community job

Custodial

• May be unable to achieve sufficient skills to care for basic needs

 • Receiving education experiences that are increasing their adaptive skills in family and community
settings
• The term is now rarely used

Prevalence

• 11% of all students with disabilities are classified with mental retardation
• 611,076 children aged 6-21 years old
• Approximately 2.5% (6 million) of the general population would be classified as mildly retarded
• The remaining 0.5% (over 1 million) would fall into the range of moderate through profound mental
retardation

Down Syndrome

• 1 in every 1,000 children

• Has 47 chromosomes instead of 46

Characteristics

• Learning and memory

▪ Less able to grasp abstract concepts
▪ Only benefits from instruction that is concrete, meaningful, and useful
▪ Learns at a slower rate and are often unable to generalize learned information to new
situations without additional instruction and support
▪ Memory problems are attributed to difficulty focusing on relevant stimuli in learning
situations
• Self-regulation
▪ Do not appear to develop efficient learning strategies
▪ Experience difficulties with metacognitive processes and experience difficulties finding,
monitoring, or evaluating the best strategy to use when confronted with a new learning
situation
• Adaptive Skills
▪ Higher rates of distractibility and inattentiveness
▪ Poor interpersonal skills related to working cooperatively with peers, social perceptions,
failure to read social cues, use of socially acceptable language, and acceptable responses
▪ Lower self-image and a greater expectancy for academic and socially failure
▪ Poor emotional development related to avoidance of work and social experiences as
exemplified by tardiness, idleness, and social withdrawal
 • Academic Achievement
▪ Significant deficits in the areas of reading and mathematics
▪ Poor reading mechanics and comprehension
▪ Can be taught to read at least protective or survival vocabulary
• Motivation
▪ Associated with history of failure and difficulties related to memory and learning
▪ Helplessness
• Speech and Language characteristics
▪ Articulation, voice, and stuttering problems
▪ Generally associated with delays in language development
• Physical Characteristics
▪ Significant probability of related physical problems
▪ The more severe the mental retardation, the greater the probability of multiple disabilities
▪ Increasing health problems may be associated with genetic or environmental factors and
living conditions

Causation

• Sociocultural influences
• Biomedical factors
• Behavioral factors
• Traumas or physical agents
• Unknown prenatal influences

Prevention

• Immunization
• Proper nutrition
• Appropriate prenatal and neonatal care
• Genetic screen

Management

• Take one step at a time

• Introduce motivators for learning such as generous phrase
• Reduce the number of extra stimuli present so that the child can keep attention focused on the task
or realize that it is more important that surrounding stimuli
 • Demonstrate skills to be learned
• Keep things simple
• Give phrase accordingly

Autism

• Very complex, often baffling developmental disability

• “auto” – children are “locked within themselves”
• Considered to be an emotional disturbance
• Severe form of a broader group of disorder
• Referred to as pervasive developmental disorders
• Typically appears during the first 3 years of life

Asperger’s Syndrome

• Mild autism
• Impairments in social interactions and presence of restricted interests and activities
• No clinically significant general delay in language
• Average to above average intelligence

Characteristics

• Social Interaction Problems

• Impaired Communication/Language
▪ Autism impacts normal development of the brain in areas of social interaction and
communication skills
• Occasionally, aggressive or display self-injurious behavior
• May exhibit repeated body movements (hand flapping, rocking)
• Unusual responses to people
• Decreased Play
• Attachment to objects
• Resistance to change in routine
• Sensory sensitivities
Prevalence

• Prevalence is 2-6/1000 individuals

• 4 times more prevalent on boys
• No known racial, ethnic, or social boundaries
• No relation to family income or lifestyle

Diagnosis

• No definitive medical test

• Team uses interviews, observation, and specific checklists developed for this purpose
• Team might include neurologist, psychologist, developmental pediatrician, speech/language
therapist, learning consultant, etc.
• Must rule oout MR, hearing impairment, behavior disorders, or eccentric habits

Causation

• Very likely neurological in origin

• Abnormalities in brain development, neurochemistry, and genetic factor

Interventions

• Behavior Modification
• Relaxation and massage
• Holding Therapy
• Speech Therapy
• Speech Therapy
• Psychotherapy

Management

• Assist in child’s judgment

• Provide a predictable environment
• Allow certain amounts of time to perform the rituals then move the child into expected activity.
• Do not reward rituals by smiling/laughing at the behavior
• Give specific instructions for behavior and reward these behaviors.
 • Reward attempts to communicate needs verbally and share appropriate language.
• Help the child discuss and identify feelings
• Teach appropriate means of expressing feelings through word and physical activities.
• Include non-threatening activities with peers.
• Keep the child present in routine environment.
• Maintain eye contact with the child during conversation.
• Ask the child to look at the adult or other child while talking and reinforce the children for this
behavior.

Spinal Muscular Atrophy (SMA)

• Usually inherited as autosomal recessive disorders: with rare cases having autosomal dominant
inheritance
• Incidence is 20/100,000
• Range in severity from severe generalized paralysis requiring ventilator support at birth, to
relatively mild, slowly, progressive conditions presenting in the second or third decade of life

Type 1 SMA (Infantile SMA, Werdnig-Hoffman Disease)

• Age of survival by the time of diagnosis is 6-9 months and does not excess 3 years
• Onset is noted between birth and 6 months of age
• Acute ventilatory failure can occur between 3 and 4 years of others
• Floppy or hypotonic with generalized weakness
• Feeding difficulty and breathing apparent
• The infant lies motionless with the lower limbs abducted in a frog leg position

Type 2 SMA (Juvenile SMA)

• Slowly progressive
• Clinical signs are present by the age of 3 years but occasionally occur as early as 3 months of age
• Age of death is 12 years old with some surviving at the age 30
• Weakness and atrophy are predominantly occurring on the proximal part of the lower limb with
minimal involvement of the upper limbs
• Sensation is normal
• Owing to the gradual progressive weakness scoliosis and equines deformities usually develop as
the disease progresses
Types 3 SMA (Kugelberg-Welander Disease)

• Characterized by slowly progressive weakness and atrophy of the proximal and limb girdle muscles
• Onset of disease can occur anytime between childhood and 7 th year of life but is usually between
the ages od 2-17 years
• Symmetrical atrophy and weakness of the pelvic girdle and proximal lower limbs followed by
involvement of the shoulder girdles and upper arms, leg, and forearm muscles affected later
• Loss of spinal motor neurons

Type 4 SMA (Adult-onset SMA)

• Symptoms typically begins after the age of 35

• Less common than other forms
• Onset of weakness after 18 years of age, and most cases reported as Type IV have occurred after
age of 35

Treatment (Drug of Choice) : nursinersen

Management

• Assist in ambulation
• Assist in using assistive devices
• Strengthen affected muscles

Attention Deficit Hyperactivity Disorder (ADHD)

• A neurobiological condition characterized by developmentally inappropriate level of attention,

concentration, activity, distractibility, and impulsivity
• Inactivity
▪ Daydreaming
▪ acts as deaf and disorganized
• Hyperactivity
▪ Always on the go
▪ Cannot sit still/wandering
▪ Can’t keep hands on self
 • Impulsivity
▪ Daredevil
▪ Impatient/demanding
▪ Disruptive

Treatment (Drug of Choice) : Ritalin and Dexedrine

Management

• Modify the environment to reduce distraction

• Provide clear instructions
• Focus on success
• Help your child organize
• Encourage your child to control impulses
• Encourage active learning