VI SEMESTER:

PAPER VII - ABNORMAL PSYCHOLOGY

Chapter 5: Mental retardation

Terms used: Mental retardation, mental deficiency, mental abnormality and mental handicap.
Previously known as amentia, feeble minded, idiocy, oligophrenia
Definition given by American Association on MR (AAMR) in 1983: MR refers to significantly
sub-average intellectual functioning, resulting in or associated with concurrent impairments in
adaptive behavior and manifested during the developmental period (before 18 years).
o General intellectual functioning: - results obtained by administration of standardized general
intelligence tests developed for the purpose and adapted to the conditions of the region/country.
o Significantly sub-average: - IQ of 70 or below on standard test of intelligence -> up to 75.
o Development period:- Conception to 18 yrs
o Adaptive behavior: - degree with which the individual meets the standards of personal
independence and social responsibility expected of his age and cultural group.
Deficits in adaptive behavior in effective areas during different ages
During infancy and early childhood
Sensory and motor skill development
Communication skills
Self help skills
Socialization
During childhood and adolescence
Application of basic academic skills to daily life activities of appropriate reasoning and judgment
in the mastery of the environment
Social skills
Late adolescence and adulthood
Vocational and social responsibilities and performance.

LEVELS OF MR
Mild retardation (IQ 50to 70)

educable
Social adjustment is not so good as normal like thinking, imagination etc.
Some level of supervision
Can do simple academic and occupational skills and also self supporting.

Moderate retardation (IQ 35to 50)

trainable able to master certain routine skills

they attain intelligence of 4-7years
They can be taught to read and write and can manage to talk.
rate of learning is slow
looks clumsy and ungainly (awkward), body deformities and poor coordination
hostile and aggressive
Extra abilities like music might be present.
Partial independence can be achieved.

Severe retardation (IQ 20to 35)

dependent retarded
motor and speech are severely retarded
Sensory defects and motor handicaps.
They can develop personal hygiene and self help limitedly to less their dependence.

Profound retardation (IQ below 20)

life support retarded

Unable to master any skills, except very few simple tasks.
Speech will be absent and only sounds.
physical deformities, CNS pathology (fits), retarded growth
seizures, mutism, deafness
custodial care of others
Short life span.

AGE

Preschool
years
0-5 years

School age
6-20 years
Training
and
education

Adult
21 and
over

Mild
Can develop social and
communication skills.
Minimal retardation in
sensorimotor areas.
Normally not
distinguished until late
age.
Can learn academic
skills up to 6th grade
level by late teens.
Socially odd.

moderate
Can talk or learn to
communicate
Poor social awareness.
Fair motor development
training in SHS slightly

Can be managed with

moderate supervision.
Can profit from training
in social and occupational
skills.
Unlikely to progress
beyond 2nd grade level in
academics.
May travel alone to
familiar places.
Can achieve social and Needs more supervision.
vocational skills and
may need minimal
support

severe
poor motor
development
speech minimal
unable to profit from
training
no self help CNS
damage

profound
gross retardation
minimal capacity for
sensori motor
full time care
severe in cognition
abilities

can talk or learn to

communicate
Trained in health
habits.

Immobile.
Some motor
development present.
Respond to limited
self help training.

Contribute partially
to self maintenance.

needs nursing care

CAUSES OF MR
I) Prenatal period
1) Chromosomal abnormalities 23 pairs of chromosomes in each human cell. Less, more or error in
chromosome structures.
2) Genetic disorders defect in genes transmitted from parent to offspring. It may be a metabolic
abnormality or a specific enzyme absent which results in accumulation of specific substances in brain
resulting in MR. Phenylketonuria (PKU), mucopolysaccharidosis ( inborn error of metabolism of
complex carbohydrates), lipidoses (disorder of lipid metabolism within body cells).
3) Infection in mother - especially during 1st trimester. Rubella (German measles), syphilis, tuberculosis,
toxoplasmosis, HIV etc.
4) Maternal disease diabetes mellitus and high BP, problems in kidney, malnutrition, and
hypothyroidism can lead to cretinism. Hyperthyroidism can also cause MR by affecting the growing
CNS.
5) Exposure to X-rays, harmful drugs, Rx of cancer, antiepileptic drugs, fits and falls can also affect.
6) Congenital defects of CNS microcephaly, hydrocephaly and other defects of brain and spinal cord
can cause MR.
II) Prenatal causes
1) Prematurity (b/w 28- 34 weeks)
2) Low weight baby ( less than 2 kg)
3) Anoxic conditions or hypoxia
4) Prolonged labor, inappropriate size of head and birth canal
5) Abnormal position of the fetus in the uterus.
6) Excessive coiling of cord around neck
7) Abnormal position of placenta
8) Hemorrhage or bleeding in the brain of the new born
9) Severe jaundice in new born
10) Medicines of mother and high B.P.
III) Postnatal causes
1) Malnutrition: 12-18 weeks of foetal life
2) Infections like meningitis or encephalitis (brain fever)
3) Repeated fits
4) Injury due to falls and accidents
5) Kernicterus (high levels of bilirubin), cerebral palsy.

LEARNING DISORDER

Learning disorder stem from abnormalities in cognitive processing that derive from some type of
biological dysfunction.

LD is a lifelong disorder which affects the selection, retention and expression of information. The
incoming and outgoing information gets scrambled as it travels between brain and senses.

It can be seen in children with average and above average intelligence.

The child has significant deficit in one or more aspect of learning process resulting in a gap between
his potential and achievement.

The Definition by Federal Govt. of USA:-Specific learning disability means a disorder in one or more
of the basic psychological processes involved in understanding or in using language, spoken or written,
which may manifest itself in an imperfect ability to listen, think, speak, read, write, spell or to do
mathematical calculations.

The term includes such conditions as perceptual handicaps, brain injury, minimal brain dysfunction,

dyslexia and developmental aphasia.

or

The term doesnt include children who have learning problems primarily as a result of visual hearing
motor handicaps or MR; emotional disturbances or environmental, cultural or economic

disadvantages.

A LD child typically shows:

1) Hyperactivity - although relationship between 2 is not substantiated.

2) Impulsivity - Blackman &Goldstein (1982) suggested that when learner does not how to respond to
incoming stimuli, he produces an incorrect response by either ignoring the relevant features of the task
(impulsivity) or responds with excessive activity (hyperactivity)
3) Disorders of Attention - Short attention span and lack of concentration.
They are inferior in selective attention.
Cannot sustain or maintain attention till end of the task.
Inattention can be due to many causes physical problems, anxiety, stress etc.
4) Memory problems characterised by inefficient memory systems, unable to spontaneously use
rehearsal strategies, recode information in a meaningful way. Inability to retrieve store information,
Difficulty in recall visual material, especially written words.
5) Emotional problems
6) Specific academic problems In the area of academic learning, they are low achievers.
Problems in reading, writing, spellings & maths
Dyslexia - Inability to read. Try to guess while reading, omitting or adding words, poor vocabulary,
poor comprehension. Fails to perceive and analyze distinctive features automatically. They discard
sequential features of stories affecting comprehension and less focus on meaning.

Dysgraphia area of written expression is affected. The total number of words and length of sentences
is reduced. Errors in spelling, syntax, tenses and punctuation. They are unable to deal with abstract
themes and ideas.
Dyscalculia Unable to associate numbers with quantity. Left-right confusion, tendency to reverse
numbers, before and after, and problems with spatial orientation. The ability to make estimations of
space, size, time, shape and weight is poor and they are poor in problem solving.
7) Disorders of Speech and Hearing

Hearing: Listening is a complex process which involves attention to sound, discriminate between
sounds to gather relevant features of what is said, future retrieval. The person cannot recognize
words having multiple meaning or words used in different contexts. Difficult in understanding
sarcasm, humor. Since listening is impaired, it affects speech.

Speech - Simple sentence construction, Incorrect usage of word, Problems with tense, pronouns,
possessives, Omission of words and words endings, Insertion of extra words, articulation
difficulties, awkward organization of spoken language, Difficulty in retrieving words during
conversation.

8) Perceptual Motor Problems-Ability to receive and make sense of incoming stimuli.

Visual perception deficits - figure ground discrimination, spatial relationship, visual motor
integration (problems in cutting, pasting, buttoning etc)

Auditory perception deficits - ability to select sound from environment and the data gets organized,
Auditory discrimination (ability to hear differences and similarity b/w two or more sounds),
auditory blending-for reading, ability to blend or combine sounds to form words and auditory
memory.

9) Motor Deficiencies Fine and Gross motor skills and problems

10) EEG Abnormalities.

Causes of LD
1) Neurological Damage: share several characteristics of persons with brain damage, damage during
pre, peri and postnatal period. Laterality of the lesion, site and size of lesion.
2) Maturational Delay
3) Genetic factors
4) Biochemical factors: imbalance in release of biochemicals leads to hyperactivity.
5) Nutritional deficits: food leads to hyperactivity
6) Role of environment: economically deprived home, emotionally unstable home, poor teacher and
quality

Pervasive Developmental Disorders

Pervasive developmental disorders include several that are characterized by impaired reciprocal social
interactions, abnormal language development, and restricted behavioral repertoire. Pervasive
developmental disorders typically emerge in young children before the age of 3 years, and parents often
become concerned about a child by 18 months as language development does not occur as expected.
Autistic disorder/Autism (historically called early infantile autism, childhood autism) is characterized by
symptoms from each of the following three categories:
i)
ii)
iii)

Qualitative impairment in social interaction,

Impairment in communication, and
Restricted repetitive and stereotyped patterns of behavior or interests.

According to the DSM-IV-TR, to meet criteria for autistic behavior, abnormal functioning in at least one
of the above areas must be present by age 3 years. More than two thirds of children with autistic disorder
have mental retardation, although it is not required for the diagnosis.
In 1943 Leo Kanner, coined the term infantile autism and provided a clear, comprehensive account of the
early childhood syndrome. He described children who exhibited extreme autistic aloneness; delayed or
deviant language development with echolalia; monotonous repetitions of noises or verbal utterances;
excellent rote memory; limited range of spontaneous activities, stereotypies, and mannerisms;
maintenance of sameness and dread of change; poor eye contact; abnormal relationships with persons; and
a preference for pictures and inanimate objects. Before 1980, children with pervasive developmental
disorders were generally diagnosed with childhood schizophrenia. Over time, it became evident that
autistic disorder and schizophrenia were two distinct psychiatric entities.
Autistic disorder is believed to occur at a rate of about 8 cases per 10,000 children (0.08 percent). By
definition, the onset of autistic disorder is before the age of 3 years, although in some cases, it is not
recognized until a child is much older. Autistic disorder is four to five times more frequent in boys than in
girls. Girls with autistic disorder are more likely to have more severe mental retardation.
Clinical Picture of Autism
Varying degrees of impairments & capabilities (savant skills)
Less attention to social stimuli
Smile & looks less often, poor eye contact
No turn taking, doesnt point out things
Aloof and never responded when picked
Dont show need for affection
Restricted/absence of speech, echolalia
Imitative deficit
Poor comprehension
Limited and solitary routine
Deficits in joint attention to make speech
Lack of imaginative play
Resistance to change (maintain sameness)

 Self stimulation in the form of repetitive movement (head banging, body rocking, spinning,
moving of fingers also known as stereotypic behavior)
Self injurious behavior
They show difficulties in relationships
Some children with autistic disorder exhibit sudden mood changes, with bursts of laughing or
crying without an obvious reason.
Hyperactivity

Causal factors
The causes are unknown, no single cause.
Abnormalities in brain structure (difference in shape and structure) and function
Genetic factors: Current evidence supports a genetic basis for the development of autistic disorder in most
cases, with a contribution of up to four or five genes. It now appears that multiple genes are involved in
the development of autism. Researchers hypothesize that some genetic forms of autism may be identified
in the near future. Defective genes (irregular/unstable genes) or damage from radiation and other
conditions during prenatal period.
Biological factors: Autistic disorder is also associated with neurological conditions, notably congenital
rubella, phenylketonuria (PKU), and tuberous sclerosis. Autistic children have higher than expected
histories of perinatal complications compared with the general population and also compared with
children with other psychiatric disorders.
Immunological Factors: Several reports have suggested that immunological incompatibility (i.e.,
maternal antibodies directed at the fetus) may contribute to autistic disorder. The lymphocytes of some
autistic children react with maternal antibodies, which raise the possibility that embryonic neural or
extraembryonic tissues may be damaged during gestation.
Perinatal Factors: A higher-than-expected incidence of perinatal complications seems to occur in infants
who are later diagnosed with autistic disorder. Maternal bleeding after the first trimester and meconium in
the amniotic fluid have been reported in the histories of autistic children.
Influenza during pregnancy - doubles autism risk for the child.
Persistent fever during pregnancy - that lasted for at least one week triples autism risk for the
child.
Antibiotic usage during pregnancy - slightly raises autism risk for the child
Environmental causes: Presence of toxins, heavy metals like mercury, pesticides and childhood
vaccines. Air traffic pollution during pregnancy and autism link - if a pregnant mother is
exposed to air traffic pollution during her pregnancy, the risk of autism in her offspring is greater.
Parents with bipolar disorder or schizophrenia - a child whose parent, brother, or sister has been
diagnosed with bipolar disorder or schizophrenia has a higher risk of being diagnosed with an ASD
Older fathers - if the father is older during conception, there is a greater risk of autism for the baby.
Scientists explained that an older father has a greater chance of passing on new mutations to his babies
than older mothers.
Certain chemicals in the brains of children between 3 and 10 years of age with an ASD (autism spectrum
disorder) develop differently compared to those with idiopathic (of unknown cause) developmental
disorders.

Treatment
The goals of treatment for children with autistic disorder are to target behaviors that will improve their
abilities to integrate into schools, develop meaningful peer relationships, and increase the likelihood of
maintaining independent living as adults.
To do this, treatment interventions aim to increase socially acceptable and prosocial behavior, to decrease
odd behavioral symptoms, and to improve verbal and nonverbal communication. Both language and
academic remediation are often required.
In addition, treatment goals generally include reduction of disruptive behaviors that may be exacerbated
especially during transitions and in school. Children with mental retardation need intellectually
appropriate behavioral interventions to reinforce socially acceptable behaviors and encourage self-care
skills. In addition, parents need support and counseling and home based training is to be given on how to
handle the children.