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Title: Disorders of Childhood and Adolescence Chapter 15


1
Disorders of Childhood and Adolescence Chapter 15
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Disorders of Childhood and Adolescence Pervasive
Developmental Disorders
  • Pervasive Developmental Disorders Severe
    qualitative impairment in verbal and nonverbal
    communication and social interaction (autistic
    disorder, Aspergers disorder, etc.).

4
Disorders of Childhood and Adolescence Pervasive
Developmental Disorders
  • Autism Spectrum Disorders Severe impairment in
    social interaction and communication skills and
    display of stereotyped interests and behaviors.
  • Autistic disorder
  • Retts disorder
  • Childhood disintegrative disorder
  • Aspergers disorder
  • Pervasive developmental disorders not otherwise
    specified

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Disorders of Childhood and Adolescence Pervasive
Developmental Disorders
  • Autistic Disorder Qualitative impairment in
  • Social interaction and/or communication.
  • Appears to view other people as just another
    object.
  • Restricted, stereotyped interest and activities
  • Delays or abnormal functioning in a major area
    prior to age 3
  • Prevalence 11,000 children, 4-5 times more
    likely in boys than in girls
  • 75 have IQ below 70, 20 are average or above
    (splinter skills and autistic savants).

8
Disorders of Childhood and Adolescence Pervasive
Developmental Disorders
9
Disorders of Childhood and Adolescence Pervasive
Developmental Disorders Autistic Disorder
  • Problems diagnosing autism
  • Other medical conditions mimic behavioral
    characteristics.
  • Symptoms seen in children with and without signs
    of neurological impairment.
  • Shares characteristics with other disorders.
  • Symptoms vary for each child.
  • Overlap symptoms of other pervasive development
    disorders and often coexists with retardation.

10
Disorders of Childhood and Adolescence Pervasive
Developmental Disorders Impairments
  • Research on social unresponsiveness and unusual
    communication patterns lends support to clinical
    observations in some areas
  • Autistic children are more interested in
    inanimate objects than in humans.
  • Autistic infants dont engage in social gazing or
    in pretend play.
  • Unable to attribute mental states to others or
    understand thoughts/feelings of others.
  • Are brutally honest and dont understand humor.

11
Disorders of Childhood and Adolescence Pervasive
Developmental Disorders Impairments
  • Verbal and Nonverbal Communication
  • About 50 of autistic children do not develop
    meaningful speech.
  • Oddities such as echolalia often present.
  • Reversal of pronouns common, I instead of me or
    you instead of I.

12
Disorders of Childhood and Adolescence Pervasive
Developmental Disorders Impairments
  • Activities and Interests
  • Unusual repetitive habits or interests.
  • May show intense interest in self-produced
    sounds.
  • Minor changes in the environment can produce
    tantrums or rages.
  • Show a lack of imaginary activities.

13
Disorders of Childhood and Adolescence Pervasive
Developmental Disorders Impairments
  • Intelligence
  • As many as ¾ of children with autism have IQ
    scores less than 70.
  • Some display splinter skills such as drawing,
    puzzles, or rote memory.

14
Disorders of Childhood and Adolescence Pervasive
Developmental Disorders
  • Aspergers Disorder
  • Significant impairment in social interaction
    skills, limited and repetitive interests/activitie
    s, lack of emotional reciprocity.
  • No significant delay in cognitive or linguistic
    development.
  • Subtle difficulties with communication skills.
  • Five times more common in males than females.

15
Disorders of Childhood and Adolescence Pervasive
Developmental Disorders
  • Childhood Disintegrative Disorder Autistic-like
    symptoms after at least two years of normal
    development.
  • Retts Disorder (only occurs in females)
  • Onset between 5-48 months, after initially normal
    development
  • Deceleration of head growth, loss of purposeful
    hand skills replaced by stereotyped hand
    movements, severely impaired language
    development, loss of social interaction skills.

16
Disorders of Childhood and Adolescence Pervasive
Developmental Disorders
  • Pervasive Developmental Disorder Not Otherwise
    Specified
  • Pervasive and severe impairment in reciprocal
    social interactions, communication abnormalities
    and limited interests/activities.
  • Atypical for age of onset/specific behavior
    patterns

17
Disorders of Childhood and Adolescence Pervasive
Developmental Disorders Autistic Disorders
  • Etiology
  • Familial autism
  • Autism related to medical condition
  • Autism associate with nonspecific brain
    dysfunction
  • Autism without family history or associated brain
    dysfunction

18
Disorders of Childhood and Adolescence Pervasive
Developmental Disorders Autistic Disorders
  • Explanations
  • Psychodynamic Theories
  • Deviant Parent-child interactions lead to autism
  • Refrigerator moms (parents who are successfully
    autistic that happened to defrost long enough to
    have a child)
  • Cold, humorless perfectionists who preferred
    reading, writing, playing music, or thinking.

19
Disorders of Childhood and Adolescence Pervasive
Developmental Disorders Autistic Disorders
  • Explanations
  • Family and genetic studies
  • 2-9 of siblings of autistic children have the
    disorder (100 to 200 times greater than general
    population).
  • Greater for MZ than for DZ twins
  • Folstein Rutter Diathesis stress model
  • 36 concordance rate for identical twins
  • In 12 of the 17 discordant MZ twin pairs there
    was evidence of birth trauma for the affected
    twin.

20
Disorders of Childhood and Adolescence Pervasive
Developmental Disorders Autistic Disorders
  • Explanations
  • Central Nervous System Impairment
  • Brain dysfunction could be inherited.
  • Children with autism have higher rates of other
    chromosomal malfunctions (i.e. pku).
  • ¼ to 1/3 of those with autism also have seizures.
  • Certain brain structure differences found but no
    consistent pattern of differences found.

21
Disorders of Childhood and Adolescence Pervasive
Developmental Disorders Autistic Disorders
22
Disorders of Childhood and Adolescence Pervasive
Developmental Disorders Autistic Disorders
  • Explanations
  • Mirror Neuron System Impairment
  • The mirror neuron system (MNS) theory of autism
    hypothesizes that distortion in the development
    of the MNS interferes with imitation and leads to
    autism's core features of social impairment and
    communication difficulties.

23
Disorders of Childhood and Adolescence Pervasive
Developmental Disorders Autistic Disorders
  • Explanations
  • Biochemical Elevated levels of serotonin,
    dopamine, and neural growth factors in some
    children with autism.

24
Disorders of Childhood and Adolescence Pervasive
Developmental Disorders Autistic Disorders
  • Explanations Cognitive Theories
  • Hyper-systemizing hypothesizes that autistic
    individuals can systematizethat is, they can
    develop internal rules of operation to handle
    internal eventsbut are less effective at
    empathizing by handling events generated by other
    agents. It extends the extreme male brain theory,
    which hypothesizes that autism is an extreme case
    of the male brain, defined psychometrically as
    individuals in whom systemizing is better than
    empathizing.

25
Disorders of Childhood and Adolescence Pervasive
Developmental Disorders Autistic Disorders
  • Explanations
  • Mercury as a cause
  • Vaccines often contain high levels of mercury as
    a stabilizing agent.
  • Pregnant mothers that eat a lot of fish that are
    high in mercury?
  • WiFi might disrupt the formation of an efficient
    neural network in the developing brain.

26
Disorders of Childhood and Adolescence Pervasive
Developmental Disorders Autistic Disorders
  • Screening Parents are usually the first to
    notice unusual behaviors in their child.
  • As postponing treatment may affect long-term
    outcome, any of the following signs is reason to
    have a child evaluated by a specialist without
    delay
  • No babbling by 12 months.
  • No gesturing (pointing, waving goodbye, etc.) by
    12 months.
  • No single words by 16 months.
  • No two-word spontaneous phrases by 24 months.
  • Any loss of any language or social skills, at any
    age.

27
Disorders of Childhood and Adolescence Pervasive
Developmental Disorders Autistic Disorders
  • Treatment
  • Difficult to treat due to communication/social
    impairments.
  • Some limited success with Parents, family
    therapy, drug therapy, and behavior modification.
  • Aspergers Verbally mediated therapies
  • Drug therapy Antipsychotics, secretin
  • Behavior modification to decrease harmful
    behaviors and increase appropriate behaviors.

28
Disorders of Childhood and Adolescence Pervasive
Developmental Disorders Autistic Disorders
  • Prognosis Mixed but better for high-functioning
    (especially Aspergers)
  • 25 function in supported environment
  • 25 live independently with social impairment
  • Prognosis better for those characterized as high
    functioning.

29
Disorders of Childhood and Adolescence Pervasive
Developmental Disorders Autistic Disorders
  • State sponsored services stop at age 21 but
    autism does not stop.
  • Many autistic people need constant lifetime
    support.

30
Disorders of Childhood and Adolescence Other
Developmental Disorders
  • Childhood disorders Vague, arbitrary
    interpretations of deviation from norm.
  • Cultural factors play a role in determinations
  • Common disorders
  • Attention Deficit/Hyperactivity Disorders
  • Disruptive Disorders
  • Separation-Anxiety Disorders
  • Tic Disorders
  • Reactive Attachment Disorder
  • Elimination Disorders

31
Behavioral Symptoms Reported by Teachers of
Children in Four Countries
32
Disorders of Childhood and Adolescence Other
Developmental Disorders
  • Problems with diagnosis
  • Difference between normal/abnormal may be a
    matter of degree.
  • Abnormal behavior may be a childs adaptation
    to a difficult situation.
  • Diagnostic guidelines are vague and depend on
    clinical judgment.
  • Judgment of whether a problem exists is in the
    eye of the beholder.
  • Diagnosis becomes a label.

33
Disorders of Childhood and Adolescence Attention
Deficit/Hyperactivity Disorders and Disruptive
Behavior Disorders
  • Socially disruptive behaviors, distressing to
    others
  • Attention Deficit/Hyperactivity Disorders (ADHD)
  • Oppositional Defiant Disorder (ODD)
  • Conduct Disorder (CD)
  • Often co-occur and symptoms overlap
  • Inattention, overactivity, aggression
  • Early identification and intervention are
    imperative.

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Disorders of Childhood and Adolescence Attention
Deficit/Hyperactivity Disorders
  • Attention Deficit Hyperactivity Disorder
    Socially disruptive behaviors (attentional
    problems or hyperactivity) present before age 7
    and persist for at least 6 months.
  • Three types
  • predominantly hyperactive-impulsive
  • predominantly inattentive
  • combined
  • Prevalence 3-7 of school-aged children, more in
    boys than in girls
  • Persists through adolescence 30-50 continue
    with symptoms into adulthood

36
Disorders of Childhood and Adolescence Attention
Deficit/Hyperactivity Disorders
  • I. Either A or B
  • A. Six or more of the following symptoms of
    inattention have been present for at least 6
    months to a point that is disruptive and
    inappropriate for developmental level
  • Often does not give close attention to details or
    makes careless mistakes in schoolwork, work, or
    other activities.
  • Often has trouble keeping attention on tasks or
    play activities.
  • Often does not seem to listen when spoken to
    directly.
  • Often does not follow instructions and fails to
    finish schoolwork, chores, or duties in the
    workplace (not due to oppositional behavior or
    failure to understand instructions).
  • Often has trouble organizing activities.
  • Often avoids, dislikes, or doesn't want to do
    things that take a lot of mental effort for a
    long period of time (such as schoolwork or
    homework).
  • Often loses things needed for tasks and
    activities (e.g. toys, school assignments,
    pencils, books, or tools).
  • Is often easily distracted.
  • Often forgetful in daily activities.
  • B. Six or more of the following symptoms of
    hyperactivity-impulsivity have been present for
    at least 6 months to an extent that is disruptive
    and inappropriate for developmental level
  • Often fidgets with hands or feet or squirms in
    seat.
  • Often gets up from seat when remaining in seat is
    expected.
  • Often runs about or climbs when and where it is
    not appropriate (adolescents or adults may feel
    very restless).
  • Often has trouble playing or enjoying leisure
    activities quietly.
  • Is often "on the go" or often acts as if "driven
    by a motor".
  • Often talks excessively.
  • Impulsiveness

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Disorders of Childhood and Adolescence Attention
Deficit/Hyperactivity Disorder
  • Etiology
  • Neurological/central nervous system

38
Disorders of Childhood and Adolescence Attention
Deficit/Hyperactivity Disorder
  • Etiology
  • Some researchers believe that certain foods or
    food additives produce physiological changes in
    the brain or other parts of the body, resulting
    in hyperactive behaviors.
  • Little support from research

39
Disorders of Childhood and Adolescence Attention
Deficit/Hyperactivity Disorder
  • Etiology
  • Family variables Could be heredity or
    environment.
  • Higher prevalence rates in the first- and
    second-degree relatives of children with ADHD.
  • Higher concordance rates among MZ than DZ twins.

40
Disorders of Childhood and Adolescence Attention
Deficit/Hyperactivity Disorder
  • Etiology
  • Based on the fact that stimulant medications have
    been used effectively to treat ADHD, it is
    believed that the disorder may be caused by
    inadequate levels of dopamine in the central
    nervous system.

41
Disorders of Childhood and Adolescence Attention
Deficit/Hyperactivity Disorder
  • Treatment
  • Drug therapy (controversial)
  • 75-90 of children with ADHD respond positively
    to stimulant medication (mainly Ritalin).
  • Treats symptoms rather than causes.
  • Direct effects on the school achievement of ADHD
    children are seldom seen.
  • Family dynamics/child management
  • If behavior is a response to environment, then
  • Optimal Medication plus behavioral treatment.

42
Disorders of Childhood and Adolescence Oppositiona
l Defiant Disorder
  • Oppositional Defiant Disorder Pattern of
    negativistic, argumentative, and hostile behavior
    in which the child often
  • Loses temper
  • Argues with adults
  • Defies or refuses adult requests
  • Refuses to take responsibility for actions,
    anger, resentment, blaming others, and spiteful/
    vindictive behavior
  • However, no serious violations of others rights
  • Associated with parent-child conflict

43
Disorders of Childhood and Adolescence Conduct
Disorders
  • Conduct Disorders Persistent pattern (at least
    12 months) of antisocial behaviors that violate
    the rights of others.
  • Behaviors may include bullying, lying, cheating,
    fighting, temper tantrums, destruction of
    property, stealing, setting fires, cruelty to
    people and animals, assaults, rape, and truant
    behavior.

44
Disorders of Childhood and Adolescence Conduct
Disorders
  • Characteristics
  • Reflect individual dysfunction, not reaction to
    social and economic environment.
  • Males display aggression, females more likely to
    display truancy, running away, substance abuse,
    prostitution, chronic lying.
  • Prevalence 1-10 of children/adolescents
  • More common in males in urban settings

45
Disorders of Childhood and Adolescence Conduct
Disorders
  • Two types
  • Childhood-onset (at least one conduct problem
    before age 10)
  • Higher chronicity, more serious, poor prognosis.
  • Greater risk for adult antisocial personality
    disorder and criminal behavior.
  • Adolescent-onset (conduct problem first occurs
    after age 10)
  • Also display internalizing symptoms (withdrawal,
    depression)

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Disorders of Childhood and Adolescence Conduct
Disorders
  • Etiology
  • Psychodynamic Anxiety conflict from inadequate
    relationship with parents .
  • Biological Genetic factors
  • Behavioral Ineffective punishment of
    misbehavior
  • Lack of parental monitoring.
  • Inconsistent disciplinary practices.
  • Failure to use positive management techniques or
    teach social process skills.
  • Failure to teach academic success skills.

48
Disorders of Childhood and Adolescence Conduct
Disorders
  • Treatment
  • Resistant to traditional forms of psychotherapy.
  • Training in social and cognitive skills is
    promising.
  • Parent management training has been successful.
  • Curricular interventions for aggressive behavior
    on the playground reduce aggressive actions.

49
Disorders of Childhood and Adolescence Conduct
Disorders School Violence
  • Goldstein Catch aggression when low to prevent
    it from escalating.
  • Zero tolerance policies
  • Exposure to violence in the community and the
    media.
  • U.S. Safe and Comprehensive Schools Project
  • Peer reporting of harmful behavior
  • Shift in focus from harsh punishment to
    prevention.

50
Disorders of Childhood and Adolescence Anxiety
Disorders
  • Exaggerated autonomic responses and
    apprehensiveness in new situations
  • Internalizing, overcontrolled disorders
  • Good prognosis, often spontaneous
  • Separation Anxiety Disorder (SAD) Excessive
    anxiety over separation from parents and home at
    least 4 weeks, prior to age 18 includes school
    phobia.
  • Psychodynamic Overdependence on mother
  • Learned behavior
  • Cognitive-behavioral treatment effective
  • Medication sometimes used

51
Disorders of Childhood and Adolescence Reactive
Attachment Disorder
  • Reactive Attachment Disorder Extreme disturbance
    in relating to others socially.
  • Inhibited Type Difficulty with age-appropriate
    responding or initiation of social interactions.
  • Disinhibited Type Socializes easily but
    indiscriminately, may become superficially
    attached to strangers or casual acquaintances.
  • History of circumstances in which childs
    physical or emotional needs affecting formation
    of attachments were not met (e.g., abuse,
    repeated changes in primary caregiver).

52
Disorders of Childhood and Adolescence Mood
Disorders
  • 2-7 of children and adolescents (as early as
    infancy) may have depressive disorders.
  • More prevalent in adolescence and for females
  • Similar characteristics as adults but more
    negative self-concepts, self-blame,
    self-criticism bipolar children have more rapid
    cycling.
  • Link to child abuse
  • Treatments Social skills training, cognitive
    behavioral therapy, family therapy, supportive
    family therapy, medication

53
Disorders of Childhood and Adolescence Tic
Disorders
  • Tics Involuntary, repetitive, nonrhythmic
    movements or vocalizations.
  • Transient Tic Disorder Characterized by tics
    lasts longer than 4 weeks, less than 1 year.
  • Chronic Tic Disorders Characterized by tics that
    last longer than one year.
  • Tourettes Disorder Multiple motor tics, plus
    one or more verbal tics that may develop into
    Coprolalia (compulsion to shout obscenities).
  • Begins before age 18 and apparent for at least
    one year 5-3010,000 children more males than
    females.

54
Disorders of Childhood and Adolescence Tic
Disorders
  • Etiology and treatment
  • Psychodynamic Tics represent underlying
    aggressive or sexual conflicts
  • Learning theory Conditioned avoidance responses
    evoked by stress, reinforced by reducing anxiety.
  • Treatment Intentionally invoking tics repeatedly
    so that the tic becomes aversive rather than
    reinforcing.

55
Disorders of Childhood and Adolescence Tic
Disorders
  • Etiology and treatment
  • Biological
  • Genetic transmission (multigenerational families
    link with ADHD and OCD)
  • Cortical differences
  • CNS impairment in dopamine system
  • Treatments Medication, psychosurgery

56
Disorders of Childhood and Adolescence Elimination
Disorders
  • Enuresis A child at least 5 years old urinates
    during the day or night into his/her clothes or
    bed, or on the floor, at least twice weekly for
    at least 3 months.
  • Prevalence 5-10 of 5-year olds, 3-5 of
    10-year-olds, 1 into adulthood
  • Etiology Psychological stressors and/or
    biological determinants (e.g., delayed maturation
    of urinary tract).
  • Treat with medications and/or behavioral methods

57
Disorders of Childhood and Adolescence Elimination
Disorders
  • Encopresis A child at least 4 years old
    defecates in his/her clothes, on the floor, or
    other inappropriate places at least once a month
    for at least 3 months (NOT due to laxative use)
  • Prevalence 1 grade school children, more boys
    than girls
  • Associated with functional constipation, plus
    social problems, ostracism, rejection
  • Treat with medical evaluation, behavioral and
    family therapies, education about toileting
    regimens and well-organized bowel management
    program.

58
Learning Disorders
  • Characterized by academic functioning that is
    substantially below that expected of the persons
    chronological age, measured intelligence, and
    age-appropriate education
  • Prevalence
  • 2-10
  • Dropout rate at nearly 40 for those with
    learning disorders

59
Learning Disorders
  • Etiology
  • Little known about causes. Possibilities include
  • Maturational Lag
  • Misperceptions due to nervous system disorder
  • Injuries
  • Premature birth
  • Heritability
  • More boys than girls
  • Slower learning linked to irregular spelling,
    pronunciation, and structure of English language

60
Learning Disorders
  • Treatment
  • Are lifelong and do not simply go away with
    treatment
  • Teaching skills that capitalize on abilities and
    strengths

61
Mental Retardation
  • Mental Retardation Significant subaverage
    general intellectual functioning accompanied by
    deficiencies in adaptive behavior, with onset
    before age 18.
  • Movement away from institutionalization of
    retarded individuals
  • 75 of mentally retarded children can become
    completely self-supporting adults if given
    appropriate education and training.

62
Diagnosing Mental Retardation
  • DSM-IV-TR criteria
  • Significant subaverage general intellectual
    functioning (IQ score of 70 or less).
  • Concurrent deficiencies in adaptive behavior
    (social and daily living skills, lower degree of
    independence than expected for age).
  • Onset before age 18 (with onset after age 18 it
    would be considered dementia).

63
Diagnosing Mental Retardation
  • Prevalence 1-3 (depends on definition of
    adaptive functioning)
  • Characteristics Dependency, passivity, low
    self-esteem, low tolerance for frustration,
    depression, and self-injurious behavior.

64
Issues Involved in Diagnosing Mental Retardation
  • Questionable validity of IQ scores, especially
    for members of ethnic minority groups
  • Controversy of Herrnstein Murrays The Bell
    Curve
  • Alternative explanations for racial differences
  • Familiarity with mainstream middle-class culture
  • Cultural bias
  • Larry P. v. Riles IQ tests are culturally biased
  • IQ tests cannot be used to place African American
    children into classes for the retarded.

65
Issues Involved in Diagnosing Mental Retardation
  • Cultural Bias
  • Is the test based on a particular culture such
    that people not familiar with the culture are at
    a disadvantage?
  • By this definition - yes, IQ tests are biased.
  • It is very difficult (if not impossible) to
    construct a culture-free test.

66
Issues Involved in Diagnosing Mental Retardation
  • Predictive Bias
  • Is the test more predictive of future behavior
    for some groups and not for others?
  • This is a statistical definition of bias.
  • IQ are not biased in terms of their ability to
    predict equally well for all groups.
  • They have predictive validity for all groups --
    equally good predictive ability for school
    performance and for job performance across
    groups.
  • If we define fairness in terms of predictive
    bias, IQ tests are not biased.

67
Levels of Retardation
  • DSM-IV-TR classifications
  • Mild IQ score 50-55 to 70
  • Moderate IQ score 35-40 to 50-55
  • Severe IQ score 20-25 to 35-40
  • Profound IQ score below 20-25
  • AAMR considers limitations in intellectual and
    adaptive skills
  • Focuses on adaptive functioning

68
Estimated Number of Mentally Retarded People by
Level of Retardation
69
Etiology of Mental Retardation
  • Environmental factors
  • Absence of stimulation
  • Lack of attention or reinforcement from parents
    or significant others
  • Chronic stress and frustration
  • Poverty
  • Lack of adequate health care
  • Poor nutrition
  • Inadequate education

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Etiology of Mental Retardation
  • Genetic factors Normal genetic variation and
    genetic abnormalities
  • Fragile X Syndrome (affects higher control
    processes)
  • Down Syndrome Condition produced by the presence
    of an extra chromosome (trisomy 21) resulting in
    mental retardation and distinctive physical
    characteristics
  • Prevalence 11,000, but increases as mothers
    age at birth increases

72
Rate of Down Syndrome Births
73
Etiology of Mental Retardation
  • Tests for genetic anomalies
  • Amniocentesis Screening procedure in which
    amniotic fluid is withdrawn from fetal sac during
    14th-15th week to determine presence of fetal
    abnormalities.
  • Chorionic Villus Sampling Tests made of cells on
    villi on sac surrounding the fetus during 9th
    week of pregnancy.
  • Other genetic anomalies Turners syndrome,
    Klinefelters syndrome, phenylketonuria (PKU),
    Tay-Sachs disease, cretinism

74
Etiology of Mental Retardation
  • Nongenetic biological factors (prenatal)
  • Fetal Alcohol Syndrome (FAS) Group of congenital
    physical and mental defects found in some
    children born to alcoholic mothers.
  • Small body size
  • Microencephaly (brain is unusually small, leading
    to mild retardation)
  • Academic and attentional difficulties
  • Exacerbated by maternal smoking and poor nutrition

75
Etiology of Mental Retardation
  • Nongenetic biological factors (perinatal)
  • Birth trauma, prematurity, asphyxiation, low
    birth weight
  • Nongenetic biological factors (postnatal)
  • Head injuries (often resulting from child abuse),
    infections, tumors, malnutrition, ingestion of
    toxic substances (e.g., lead)
  • Most common birth condition associated with
    mental retardation Prematurity and low
    birthweight

76
Programs for People with Mental Retardation
  • Early interventions (e.g. Head Start)
  • School services
  • Modified regular classroom assignments and direct
    instructions to teach learning skills
  • Special education programs
  • Employment programs

77
Programs for People with Mental Retardation
  • Living arrangements
  • Group homes and independent/semi-independent
    living within the community are replacing
    institutionalization
  • Least restrictive environment
  • Living with ones own family
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