Unit I: ASD & Mental Retardation (MR)

1. MR: Concept and definition

2. Characteristics of MR

3. Causes of MR

4. Classification of MR

5. Educational implications for ASD children with MR

1. MR: Concept and definition

Pre-Colonial India

Historically, over different periods of time and almost till the advent of the colonial rule in India, including the reigns of Muslim kings, the rulers exemplified as protectors, establishing charity homes to feed, clothe and care for the destitute persons with disabilities. The community with its governance through local elected bodies, the Panchayati system of those times, collected sufficient data on persons with disabilities for provision of services, though based on the philosophy of charity. With the establishment of the colonial rule in India, changes became noticeable on the type of care and management received by the persons with the influence from the West.

Pre-Independence–Changing Life Styles in India

Changes in attitudes towards persons with disabilities also came to about with city life. The administrative authorities began showing interest in providing a formal education system for persons with disabilities, particularly for families which had taken up residences in the cities.

Changes in the lifestyle of the persons with mental retardation were also noticed with their shifting from ‘community inclusive settings’ in which families rendered services to that of services provided in ‘asylums’, run by governmental or non-governmental agencies (Chennai, then Madras, Lunatic Asylum, 1841).

It was at the Madras Lunatic Asylum, renamed the Institute of Mental Health, that persons with mental illness and those with mental retardation were segregated and given appropriate treatment.

Special schools were started for those who could not meet the demands of the mainstream schools (Kurseong, 1918; Travancore, 1931; Chennai, 1938). The first residential home for persons with mental retardation was established in Mumbai, then Bombay (Children Aid Society, Mankhurd, 1941) followed by the establishment of a special school in 1944. Subsequently, 11 more centres were established in other parts of India.

Post-Independent India–Current Scenario

Establishment of Special Schools

Article 41of the Constitution of India (1950) embodied in its clause the “Right to Free and Compulsory Education for All Children up to Age 14 years”.

Many more schools for persons with mental retardation were established including an integrated school in Mumbai (Sushila Ben, 1955).

Notwithstanding this obligatory clause on children’s mainstream education, more and more special schools were also being set up by non-governmental organizations (NGOs) in an attempt to meet the parents’ demands.

WHO, ICD-10- Mental retardation is a condition of  arrested or incomplete development  of the mind, which is especially characterized by impairment of skills manifested during the developmental period, that contribute to cognitive (knowledge), language, motor and social abilities.

AAIDD, 2010- Intellectual disability is a disability characterized by significant limitations both in intellectual functioning and in adaptive behavior, which covers many everyday social and practical skills. This disability originates before the age of 18.

PWD Act, 1995- Mental retardation means a condition of arrested or incomplete development of mind of a person which is specially characterized by sub normality of intelligence.

RPwD Act 2016- Intellectual disability is a condition of arrested or incomplete development of mind of a person, especially characterized by sub-normality of intelligence.

DSM-5 defines intellectual disabilities as neurodevelopmental disorders that begin in childhood and are characterized by intellectual difficulties as well as difficulties in conceptual, social, and practical areas of living. The DSM-5 diagnosis of ID requires the satisfaction of three criteria:

· Deficits in intellectual functioning—“reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience”—confirmed by clinical evaluation and individualized standard IQ testing;

· Deficits in adaptive functioning that significantly hamper conforming to developmental and socio-cultural standards for the individual's independence and ability to meet their social responsibility; and

· The onset of these deficits during childhood.

2. Characteristics of MR

Mild ID Profile

· Minor delays in the preschool period

· Evaluation often only after school entry

· 2-3 word sentences used in early primary grades

· Expressive language improvement with time

· Reading/math skills – 1^st to 6^th grade levels

· Social interests typically age appropriate

· Mental age range of 8-11 years of age

· Persistent low academic skill attainment can limit vocational possibilities

Moderate ID Profile

· More evident and consistent delays in milestones

· At school entry may communicate with single words and gestures

· Functional language is the goal

· School entry self-care skills – 2-3 year range

· By age 14:  basic self-care skills, simple conversations, and cooperative social interactions

· Mental age of 6-8 years of age

· Vocational opportunities limited to unskilled work with direct supervision and assistance

Severe ID Profile

· Identification in infancy to two years

· Often co-occurring with biological anomalies

· Increased risk for motor disorders and epilepsy

· By age 12:  may use 2-3 word phrases

· Mental age typically 4-6 years of age

· As adults assistance typically required for even self-care activities

· Close supervision needed for all vocational tasks

Profound ID Profile

· Identification in infancy

· Marked delays and biological anomalies

· Preschool age range may function as a 1-year-old

· High rate of early mortality

· By age 10:  some walk/acquire some self-care skills with assistance

· Gesture communication

· Recognizes some familiar people

· Mental age range from birth to 4 years of age

· Functional skill acquisition not likely

3. Causes of MR

Possible Sources for Causes of Intellectual Disability:

Prenatal (before birth)

–    chromosomal, maternal infections, environmental factors, unknown influences

Perinatal (during birth)

–    gestational disorders, neonatal complications

Postnatal (after birth)

–    infections and intoxicants, environmental factors

Predisposing Factors

§ No clear etiology can be found in about 75% of those with Mild MR and 30 – 40% of those with severe impairment

§ Specific etiologies are most often found in those with Severe and Profound MR

§ No familial pattern (although certain illnesses resulting in MR may be heritable)

Heredity (5% of cases)

– Autosomal recessive inborn errors of metabolism (e.g., Tay-Sachs, PKU)

– Single-gene abnormalities with Mendelian inheritance and variable expression (e.g., tuberous sclerosis)

– Chromosomal aberrations (e.g., Fragile X)

§ Early Alterations of Embryonic Development (30% of cases)

– Chromosomal changes (e.g., Downs)

– Prenatal damage due to toxins (e.g., maternal EtOH consumption, infections)

§ Environmental Influences (15-20% of cases)

– Deprivation of nurturance, social/linguistic and other stimulation

§ Mental Disorders

– Autism & other PDDs

§ Pregnancy & Perinatal Problems (10% of cases)

– Fetal malnutrition, prematurity, hypoxia, viral and other infections, trauma

§ General Medical Conditions Acquired in Infancy or Childhood (5% of cases)

– Infections, trauma, poisoning (e.g., lead)

The following table summaries the causes of Intellectual Disability:

4. Classification of MR

AAMR Classification Scheme

     I.Q.(intelligence quotient) is 100; normal ranges from 90 to 110

· Border line { IQ 70-80 }

· mild MR     { IQ 55-70 }

· moderate MR{ IQ 40-55 }

· sever MR      { IQ 25-40 }

· profound MR { IQ below 25 }

DSM IV-TR Levels of Mental Retardation

Ø Mild MR

o55-70 IQ

oAdaptive limitations in 2 or more domains

Ø Moderate MR

o35-54 IQ

oAdaptive limitations in 2 or more domains

Ø Severe MR

o20-34 IQ

oAdaptive limitations in all domains

Ø Profound MR

oBelow 20 IQ

oAdaptive limitations in all domains

AAMR Levels of Support

Intermittent - Support is not always needed. It is provided on an "as needed" basis and is most likely to be required at life transitions (e.g. moving from school to work ).

Limited - Consistent support is required, though not on a daily basis. The support needed is of a non-intensive nature.

Extensive - Regular, daily support is required in at least some environments (e.g. daily home-living support).

Pervasive - Daily extensive support, perhaps of a life-sustaining nature, is  required in multiple environments.

Medical classification

1. Infections and intoxications

2. Trauma or physical agent

3. Metabolic or nutrition

4. Gross brain disease (post natal)

5. Unknown prenatal influence

6. Chromosomal abnormality

7. Gestational disorders

8. Psychiatric disorder

9. Environmental influences

10.Other influences

Psychological classification

Based on the 1983 AAMR definition, the operational classification for persons with mental retardation is as follows:

Educational Classification

In the special education centers in India, the classroom classification in operation is as shown below:

5. Educational implications for ASD children with MR

These strategies can be implemented both in a classroom and at home.

1. Create an environment that is not over stimulating. The child will do better if there is no loud music playing in the background, as it distracts an autistic child from concentrating.

2. Create a structured environment with predictable routines. This is where the picture schedule so often used in autistic classrooms comes into play. The daily routine should be the same from day t day, only differing for special occasions. At such times, an appropriate picture representing that event should be placed on the child's schedule.

3. Give fewer choices. If a child is asked to pick a color, say red, only give him two to three choices to pick from. The more choices, the more confused an autistic child will become.

4. Select repetitive motions when working on projects. Most autistic classrooms have an area for work box tasks, such as putting erasers on pencils or sorting colors into colored cups.

5. Keep voice low and clear when teaching. Autistic children become agitated and confused if a speaking voice is too loud. Excess talking between staff members should be kept to a minimum.

6. Limit physical contact. While this is a good strategy for all children, autistic children cannot properly interpret body language and touch, so minimal body physical contact is best

7. Allow students to stand instead of sit around a table for a class demonstration or for morning or evening meeting. Many children do better when allowed to stand. Many rock back and forth and this allows them to repeat those movements while still listening to teacher instruction.

8. Encourage and promote one to one interactions with students to promote social skills. Since autistic children have a problem with social skills and appropriates social behavior this is very important. Opportunities for social interaction might have to be structured at first, but with practice, they will start to understand social interactions.

9. Eliminate stress. Again, the autistic child needs to learn in a calm and quiet classroom. IF staff members are experiencing too much stress, leave the classroom until you feel better. Autistic children pick up on emotions very easily.

10.For visual learners, be sure to use signs and pictures, such as the pictures from the Board maker program. This is the beginning of communication skills for these children.

These ten suggestions should help in educating the autistic child with less stress and in a more focused environment taking into account their limitations.