Social Work Practice
Social Work Practice SWRK 6640
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This 6 page Class Notes was uploaded by Ahmed Little on Wednesday September 30, 2015. The Class Notes belongs to SWRK 6640 at Western Michigan University taught by Robin McKinney in Fall. Since its upload, it has received 19 views. For similar materials see /class/216829/swrk-6640-western-michigan-university in Social Work at Western Michigan University.
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Date Created: 09/30/15
9 Mental Retardation Chapter Outline I Intelligence and Mental Retardation A Historical Perspectives Historically those with mental retardation were typically feared ignored and misunderstood 2 In the late l9Lh century staterun schools and institutions were responsible for persons with intellectual disabilities and special needs by the mid 1960s the inhumane conditions of these institutions were exposed 3 In the early 201h century the eugenics movement led people to see individuals with mental retardation as deviants and criminals and wide ranging attempts were made to identify and control them 4 By the mid201h century considerable progress was made toward understanding and assistng individuals with mental retardation B De ning and Measuring Children s Intelligence and Adaptiveness 1 General intellectual functioning is now de ned by an intelligence quotient IQ or equivalent which is derived from a standardized assessment 2 In addition to subaverage intellectual functioning the definition of mental retardation includes subaverage adaptive functioning how effectively an individual copes with ordinary life demands and how capable he or she is of living independently and abiding by community standards C The Controversial IQ l IQ is relatively stable over time except when measured in young normallydeveloping infants infants and children with lower IQ levels show stability over time 2 Despite its strong genetic component mental ability is always modified by environment especially in infancy through early childhood 3 The Flynn Effect refers to the phenomenon that IQ scores have risen about three points per decade since IQ testing began 4 Concern has been expressed about whether IQ tests are biased or unfair toward African Americans who typically score about 1 standard deviation below whites economic and social inequalityinot test bias or racial differencesiis the simplest explanation for differences between blacks and whites II Features of Mental Retardation A Clinical Description 1 Significantly subaverage intellectual functioning requires a person to have an IQ approximately 70 or below 2 standard deviations below the average of 100 2 Concurrent deficits or impairments in adaptive functioning refers to the ability to perform daily activities 3 Characteristics must be evident prior to age 18 4 The definition of mental retardation is somewhat inaccurate and arbitrary due to being based on a statistical concept B Degrees of Impairment DSMIVTR l Mild Mental Retardation a IQ level of 55 to 70 b Applies to as many as 85 of persons with mental retardation c Typically not identi ed until early elementary years d Overrepresentation of minority group members e With appropriate supports can usually live successfully in the community 2 Moderate Mental Retardation a IQ level of 40 to 54 b Applies to about 10 of persons with mental retardation c Usually identi ed during preschool years d Applies to many people with Down syndrome e By adulthood majority can adapt well to living in a community and can perform some work 3 Severe Mental Retardation IQ level of 20 to 39 b Applies to about 3 to 4 of persons with mental retardation c Often associated with organic causes d Usually identified at a very young age e Most require special assistance throughout their lives 4 Profound Mental Retardation a IQ level below 20 or 25 b Applies to about 1 to 2 of persons with mental retardation c Usually identified in infancy d Almost always associated with organic causes and often cooccurs with severe medical conditions e Most require lifelong care and assistance C Level of Needed Supports l DSMIVTR categories have been criticized for being stigmatizing and limiting 2 The AAMR categorizes persons with mental retardation according to their need for supportive services intermittent limited extensive and pervasive 3 Emphasis is placed on the interaction between the person and the environment in determining his or her level of functioning D Prevalence l About l3 of the population depending on what cutoff score is used 2 Slightly more males than females 3 More prevalent among children of lower SES and those from minority groups particularly for mild mental retardation differences likely due to economic disadvantages and discrimination these differences do not eXist for more severe levels 111 Developmental Course and Adult Outcomes A Developmental vs Difference Controversy 1 Developmental viewpoint consists of two hypotheses a Similar sequence hypothesis all children pass through stages of development in an identical order b Similar structure hypothesis children with mental retardation demonstrate many of the same behaviors and underlying processes as normally developing children who are at the same level of cognitive functioning 2 Difference viewpoint cognitive development of children with mental retardation is qualitatively different from that of children without mental retardation 3 The developmental position is supported for children with familial mental retardation Motivation Often children with mental retardation experience helplessness and frustration in their learning environments which leads to low expectations and limited success Changes in Progress 1 With appropriate training and opportunities children who have mild mental retardation may develop good adaptive skills in other domains 2 Slowing and stability hypothesis refers to the alternation between periods of gain and functioning and periods of little or no advance as displayed in children with Down syndrome Language and Social Development Expressive language development may be weak in children with Down syndrome 2 May show fewer signals of distress or desire for contact with caregivers which may interfere with the development of secure attachment 3 Selfrecognition is often delayed but is positive 4 As toddlers and preschoolers children with Down syndrome show evidence of delayed and aberrant functioning in internal state language which provides a foundation for selfother understanding 5 Due to deficits in social skills and socialcognitive ability children with mental retardation may end up socially isolated from their peers Emotional and Behavioral Problems 1 Emotional and behavioral disturbances in those with mental retardation is about four times greater than the general population 2 Impulse control problems anxiety problems and mood problems are common and are considered to be part of the spectrum of problems coexisting with mental retardation rather than indicators of mental disorder 3 Experience internalizing problems in adolescence like normally developing peers ADHDrelated symptoms are also commonly reported 4 Pica and selfinjurious behavior are also associated with mental retardation Other Disabilities 1 May have other physical and developmental disabilities that can affect health and development in pervasive ways such as sensory impairments cerebral palsy and epilepsy IV 2 Chance of other disability increases as the degree of intellectual impairment increases Causes Although many organic causes have been discovered the majority of cases cannot be explained especially for mild mental retardation The twogroup approach to mental retardation emphasizes the important etiological differences between organic and culturalfamilial causes 1 Organic Mental Retardation a Causes include genetic and constitutional factors such as chromosome abnormalities single gene conditions and neurobiological in uences b Usually associated with severe and profound mental retardation 2 CulturalFamilial Mental Retardation a No clear organic cause possible family history of mental retardation b Suspected causes include economic deprivation inadequate child care poor nutrition parental psychopathology c Usually associated with mild mental retardation Inheritance and the Role of the Environment Heritability of intelligence is about 50 both genetic and nongenetic factors play important roles 2 Major environmental variations can affect cognitive performance in children from disadvantaged backgrounds 3 Prenatal in uences may be misconstrued as genetic when in fact they are environmental Genetic and Constitutional Factors 1 Chromosomal abnormalities are the most common cause of severe mental retardation 2 Down syndrome results from an additional 2151 chromosome referred to as trisomy 21 which is often a consequence of nondisjunction during meiosis retardation may be due to genes having localized affect on brain development 3 FragileX syndrome is the most common cause of inherited mental retardation and is associated with the FMRl gene which is located on the X chromosome may show autismlike behaviors 4 PraderWilli syndrome and Angelman syndrome are both associated with an abnormality of chromosome 15 and are believed to be spontaneous genetic birth defects that occur at or near the time of conception 5 SingleGene Conditions syndromes affecting intellectual functioning caused by inborn errors of metabolism that cause excesses or shortages of certain chemicals necessary during particular stages of development phenylketonuria PKU is an example of a such a condition Neurobiological In uences Fetal and infant development can be affected by adverse biological conditions such as malnutrition exposure to toxic substances and prenatal and perinatal stressors Infections traumas and accidental poisonings during infancy and childhood can also lead to mental retardation 3 Prenatal alcohol exposure can lead to a Fetal Alcohol Spectrum Disorder FASD 4 Fetal alcohol syndrome the most extreme form of FASD usually results in mild retardation ADHDlike symptoms Central Nervous System CNS dysfunction facial abnormalities and growth retardation F Social and Psychological Dimensions 1 Association between social and psychological factors and mental retardation is diverse and not wellunderstood 2 Deprived physical and emotional care and social stimulation appears to be associated with some cases 3 Families of children with mental retardation contribute to the child s healthy development or alternatively to his or her decline 4 Use of social supports and community resources is helpful for parents in adapting successfully to a child with special needs 5 Early cognitive development is a strong predictor of developmental progress and selfsufficiency among children with mental retardation V Prevention Education and Treatment A The child s overall adjustment is a function of parental participation family resources and social supports combined with his or her level of intellectual functioning basic temperament and other specific deficits treatment involves a multicomponent integrated strategy that considers children s needs within the context of their individual development family and institutional setting and community B Prenatal Education and Screening 1 Many debilitating forms of retardation such as those related to fetal alcohol syndrome lead poisoning or rubella can be easily prevented if proper prenatal precautions are taken Prenatal programs provide parents with information about fetal development and stresses of childbirth and postnatal adjustment services should be culturally diverse and culturally sensitive Prenatal genetic screening may be used to determine whether a fetus has some genetic abnormality that would lead to a seriously handicapping condition C Psychosocial Treatments One of the most promising methods for enhancing intellectual and social skills is through early intervention involves caregivers and other adults in intensive childfocused activities from an early point in time Optimal timing for intervention appears to be during the preschool years and lasting benefits depend on the stability and continuation of environmental changes that foster healthy child development Behavioral techniques include shaping to teach language skills modeling and graduated guidance to teach adaptive behavior skills and social skills training Cognitivebehavioral techniques include selfinstructional training for children with some language pro ciency and metacognitive training to improve memory and learning Familyoriented interventions help families to cope with the demands of raising a child with mental retardation includes problemfocused behavior therapies for parents Some children with mental retardation may bene t from residential care the inclusion movement calls for integration of individuals with disabilities into regular classroom settings
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