The prevalence of mental retardation: Cross-cultural considerations from Sweden and the United States

Recent reports from Sweden and other European countries have shown a sharp disparity between their incidence and prevalence figures on mild mental retardation and similar figures in the U.S. (Grunewald, 1979; Martin, Blodgett, Edwards, Geer, & Melcher, 1974; Robinson & Robinson, 1976).The purpose of this paper is to provide a model of intellectual performance that might explain such disparities and predict future levels of occurrence of mild mental retardation. Such explanations should have relevance for our views on the development of intellectual ability as well as, on a practical level, planning the allocation of treatment resources. Such planning clearly depends upon the number of children having the condition in question.Over the past few decades we have progressed substantially in our ability to describe mental retardation and to differentiate it from conditions that superficially resemble it; such as, autism, learning disabilities, schizophrenia, etc., (Baroff, 1974; Robinson & Robinson, 1976). Our ability to identify variables that relate to mild mental retardation also has developed substantially, but correlation does not necessarily lead to understanding. One of the large set of variables that often is associated with mild mental retardation in the U.S. is poverty. But “poverty” is too broad a variable to be explanatory. Such a dimension is a surrogate factor standing in the place of other variables, not yet understood, that control, in part, the actual process, by which the child develops the condition of mild mental retardation (Kirk & Gallagher, 1983). A series of papers has been presented by psychologists in Sweden that allow us to address this issue.The ability to observe two cultures, Sweden and the U.S., that have both substantial similarities and differences provides a natural comparison of the prevalence of mental retardation that would be impossible to achieve through experimental manipulation. Prevalence is used here as the total number of cases present in a population group during a specific interval of time (Kramer, 1975).     

A National Survey of State Legislation defining mental retardation: implications for policy and practice after Atkins

In Atkins v. Virginia 2002, the U.S. Supreme Court held that the Eighth Amendment prohibits executing offenders who are mentally retarded. Rather than adopting a uniform definition of mental retardation, the court charged each state with defining mental retardation in a manner that enforces the constitutional restriction. An unanswered question is how states define mental retardation after Atkins, which has implications for capital defendants and forensic evaluators who conduct capital mitigation evaluations. This project identified the statutory definitions of mental retardation in each state, and grouped the definitions based on consistency with accepted clinical criteria for mental retardation. Results show that definitions of mental retardation vary considerably by state. The large majority of states, both overall and specifically among death penalty states, use criteria for mental retardation that are not entirely consistent with accepted clinical standards. As such, it is not clear whether the majority of states are effectuating the intent of Atkins. The implications of these findings for both policy and practice are discussed.     

Discriminative control of punished stereotyped behavior in humans

The purpose of this experiment was to establish discriminative control of responding by an antecedent stimulus using differential punishment because the results of past studies on this topic have been mixed. Three adults with mental retardation who exhibited stereotypy not maintained by social consequences (i.e., automatic reinforcement) participated. For each subject, stereotypy occurred frequently in the presence of a stimulus correlated with nonpunishment of stereotypy and rarely, if ever, in the presence of a stimulus correlated with punishment of stereotypy. Latency measures showed that the antecedent stimulus correlated with punishment served as the discriminative stimulus for the suppression of stereotypy. These results are important insofar as they show that discriminative control by an antecedent stimulus develops with punishment, and because it sometimes may be desirable to establish such control of socially inappropriate behavior.     

The involvement of epigenetic defects in mental retardation

Mental retardation is a group of cognitive disorders with a significant worldwide prevalence rate. This high rate, together with the considerable familial and societal burden resulting from these disorders, makes it an important focus for prevention and intervention. While the diseases associated with mental retardation are diverse, a significant number are linked with disruptions in epigenetic mechanisms, mainly due to loss-of-function mutations in genes that are key components of the epigenetic machinery. Additionally, several disorders classed as imprinting syndromes are associated with mental retardation. This review will discuss the epigenetic abnormalities associated with mental retardation, and will highlight their importance for diagnosis, treatment, and prevention of these disorders.     

Genetics and educational psychology

Background: Molecular genetics, one of the most energetic and exciting areas of science, is slowly but surely coming to educational psychology. Aims: We review recent molecular genetic research on learning disabilities as a sign of things to come in educational psychology. We also consider some misconceptions about genetics that have slowed the acceptance of genetics in educational psychology. Samples: Diverse samples of children with learning disabilities have been studied, primarily in the UK and the USA. Methods: Linkage analysis can detect genes that have large effects on learning disabilities. Association analysis can detect genes of much smaller effect size, which is important because common disorders such as learning disabilities are likely to be influenced by many genes as well as by many environmental factors. Results: For reading disability, replicated linkages have been identified on chromosomes 6, 15 and 18. A gene responsible for a rare type of language impairment has recently been identified. For common language impairment, linkages on chromosomes 16 and 19 have recently been reported. More than 200 genetic disorders, most extremely rare, include mental retardation among their symptoms, and chromosomal abnormalities are a major cause of mental retardation. Conclusions: Although finding specific genes associated with learning disabilities is unlikely to have much of a direct application for teachers in the classroom, such findings will have far‐reaching implications for diagnosis, treatment and prevention of learning disabilities and for research in educational psychology. Educational psychology has been slower to accept evidence for the importance of genetics than other areas of psychology in part because of misconceptions about what it means to say that genetics is important for common complex disorders such as learning disabilities.     

RESPONSIBILITY AND DISABILITY

Abstract: This essay explores the boundaries of the moral community—the collection of agents eligible for moral responsibility—by focusing on those just inside it and those just outside it. In particular, it contrasts mild mental retardation with psychopathy, specifically among adults. For those who work with and know them, adults with mild mental retardation are thought to be obvious members of the moral community (albeit not full-fledged members). For those who work with and theorize about adult psychopaths, by contrast, they are not members of the moral community (albeit not in such a full-fledged fashion as the insane). Both psychopaths and adults with MMR have a disability, and the essay is interested in how disability sometimes exempts one from the moral community and sometimes doesn't. It will be through two associated puzzles that we will eventually come to see the complicated tripartite relation between disability, responsibility, and moral community.     

Adolescent sex offenders with mental retardation: Literature review and assessment considerations

Working with adolescent sex offenders can be a difficult challenge. When an offender also suffers from mental retardation, this challenge increases. Unfortunately, this has been a largely ignored population, and clinicians working with this group often find little empirical work to assist them. Yet, many theorists posit that addressing sexual offending behavior when the offender is an adolescent may help prevent that behavior from continuing into adulthood. This is important because adult sexual offenders are often very difficult to treat. The current paper begins by reviewing literature on social deficits of individuals who have mental retardation. These deficits may contribute to aberrant sexual behavior among adolescents. The focus of the paper is then a review of literature on adolescent sex offenders, including those with mental retardation. We conclude this review with suggestions for assessment of adolescent sex offenders and with recommendations for future directions.     

SPECIESISM AND MORAL STATUS

Abstract: Many people believe that all human life is of equal value. Most of them also believe that all human beings have a moral status superior to that of nonhuman animals. But how are these beliefs to be defended? The mere difference of species cannot in itself determine moral status. The most obvious candidate for regarding human beings as having a higher moral status than animals is the superior cognitive capacity of humans. People with profound mental retardation pose a problem for this set of beliefs, because their cognitive capacities are not superior to those of many animals. I argue that we should drop the belief in the equal value of human life, replacing it with a graduated view that applies to animals as well as to humans.     

Siblings of children with mental retardation: Family characteristics and adjustment

Siblings of children with mental retardation may be at greater risk for adjustment problems because of family stress related to the needs of the child with mental retardation. Family dimensions were investigated to determine their relationship to sibling adjustment. Adjustment of 12 siblings of children with mental retardation was examined in relationship to family dimensions. These relationships were compared to those for children from families without a disabled child. For both groups, self concept was positively associated with family cohesion, and social competence was positively associated with family promotion of independence. For only the siblings of the mentally retarded children, family conflict was inversely related to social competence, and family organization was positively related to sibling self concept. Our results suggest that family conflict and disorganization appear to have a more negative effect in families with a child with mental retardation.     

A follow-up study of young cerebral palsied patients Some psychological, educational and vocational aspects

Abstract.— In a follow-up study of 39 non-oligophrenic spastic adolescents and young adults it was found that 85% attended normal schools, the rest went to schools for physically or mentally handicapped. If retarded children with learning difficulties were left out of account, there were no more than 10% regular problem cases, an incidence which is very close to what is found among ordinary, non-handicapped Danish school children.-With regard to vocational career, nearly 80% were estimated to be able to obtain and remain in open employment. About one third had experienced rather pronounced vocational problems either because of physical weakness and slowness, or because of personality disturbances or intellectual retardation. Females appeared generally more content with and successful in their jobs than the males. There was an overrepresentation of clients with a mild physical handicap in the problem group, indicating that it may be difficult to occupy such a "marginal" position with its easy accs to comparison and competition with the socalled normal standards.-A close relationship was found between the data from the original psychological evaluation and the course of schooling. In contrast, there was a low agreement between the childhood reports and the follow-up employment data.     

DRO contingencies: an analysis of variable-momentary schedules.

We conducted several comparative analyses to determine the relative effectiveness of variable-momentary differential-reinforcement-of-other-behavior (VM DRO) schedules. Three individuals who had been diagnosed with mental retardation participated. Results of functional analyses indicated that their self-injurious behavior (SIB) was maintained by social-positive reinforcement. Two individuals participated in a two-stage comparative analysis within multielement and multiple baseline designs. Fixed-interval (FI) and variable-interval (VI) DRO were compared in the first stage; VI DRO and VM DRO were compared in the second. All three schedules effectively reduced the participants' SIB. Treatment for the 3rd individual was conducted in a reversal design to examine the effects of VM DRO when it was implemented in isolation, and results indicated that the procedure was effective in reducing SIB. These findings suggest that VM DRO schedules may represent attractive alternatives to traditional FI schedules because momentary schedules do not require continuous monitoring and may result in higher rates of reinforcement.     

Short-Term Memory Deficits Are Not Uniform in Down and Williams Syndromes

Neuropsychological investigation of the development of the mnesic function in mental retardation has primarily focused on evaluating short-term memory (STM). Studies have often documented a reduced verbal short-term memory span in individuals with mental retardation and with Down syndrome in particular, compared to groups of mental age-matched controls. However, recent evidence suggests that verbal short-term memory is not equally impaired in all individuals with mental retardation. Findings in children with Williams syndrome are particularly relevant in this regard. Also, data concerning STM for visual information suggest that visual-object and visual-spatial working memory may be differently compromised in people with mental retardation. In particular, individuals with Williams syndrome exhibit specific difficulties in visual-spatial but not in visual-object working memory tasks compared to typically-developing children matched for mental age. Instead, people with Down syndrome show reduced performance in both visual-spatial and visual-object tests. Taken together, these results reinforce the view that intellectual disability is not a unitary condition characterized by homogeneous slowness of cognitive development but a variety of conditions in which some cognitive functions may be more disrupted than others. The finding that the working memory deficit in individuals with Williams and Down syndrome may be qualitatively differentiated also supports the hypothesis that it is not simply a manifestation of general cognitive impairment but, rather, the expression of a specific deficit of a discrete cognitive ability.     

A supported routines approach to active treatment for enhancing independence,competence and self-worth

The traditionally accepted approach to treatment in residential facilities for adults with mental retardation is examined in terms of its impact on the lives of the intended recipients and its interaction with emerging standards for treatment. It is noted that the primary emphasis in traditional treatment providing services to meet individual needs often results in the preponderance of service being directed toward the acquisition of skills required for later independent living, rather than the immediate facilitation of independence. We offer several reasons why a heavy emphasis on skill building is not only impractical but also inappropriate for meeting the real needs of adults with retardation. We suggest that a functional definition of independence from the individual's perspective would be to have a daily routine that is as free of outside assistance as possible and that is rewarding to the individual. We suggest that many persons with mental retardation already exhibit a sufficient array of behaviors from which appropriate personal routines could emerge. It is argued that functional assessments of the need for new skills should be conducted only from within such routines. We conclude that active treatment provided in this way will improve individual self-worth because its focus is on producing immediate competence and independence, rather than perpetuating the ‘student’ status of adults in residential facilities. We refer to this as a ‘supported routines’ approach. The implementation of this approach within the current standards for ‘active treatment’ is discussed, as well as the individual's right to be supported in this way.     

Learned irrelevance: A contemporary overview

This article reviews the recent literature on the topic of learned irrelevance. It asks whether the retardation of subsequent conditioning produced by uncorrelated preexposure is indeed the result of the animal learning that a conditioned stimulus (CS) and unconditioned stimulus (US) are unrelated, or whether it is better explained either as a result of the context specificity of latent inhibition, or as some other artefact of the uncorrelated schedule employed. The conclusion is that there is as yet no good evidence to support the existence of a “genuine” learned irrelevance effect.     

ASSESSING STIMULUS CONTROL IN NATURAL SETTINGS: AN ANALYSIS OF STIMULI THAT ACQUIRE CONTROL DURING TRAINING

When a learner is taught a new response, the stimuli that influence its display are often unknown. The presence or absence of these stimuli alters the probability of occurrence of the response. By identifying the stimuli influencing the probability of newly acquired responses, interventionists may program for their generalization more effectively and efficiently. This investigation describes the application of an operant methodology to assess functional relationships between responses and specific stimulus variables. Four young adults with moderate mental retardation were taught to include “please” as part of requests they made in school. Four environmental stimuli, present during training, were assessed for the controlling properties they acquired. Each of the four was assessed prior to and after training by presenting it in isolation (i.e., the other three were varied). If the presence of a single stimulus associated with training did not occasion “please,” then pairs of stimuli were probed. The results revealed that single-stimulus probing occasioned responding by only 1 learner; paired-stimulus probing set the occasion for including “please” by 2 others. Control of the 4th learner's responding was lost before training was introduced, because he began including “please” in his requests during baseline. The implications of these results are discussed in terms of analyzing stimulus control and promoting stimulus generalization.     

Sexual Abuse Prevention for Individuals with Mental Retardation: Considerations for Genetic Counselors

It is now widely recognized that children, adolescents, and adults with mental retardation are especially vulnerable to sexual abuse. Because at least 10% of genetic conditions are reported to include mental retardation as a feature, the provision of services to individuals with mental retardation represents a substantial portion of the case load for many genetic counselors. Our objective is to educate genetic counselors and other health professionals about this vulnerable population in order to enhance the frequency and efficacy of inquiry into sexual education and sexual abuse prevention training for patients with mental retardation. The following review article is intended to assist genetic counselors by increasing their knowledge of factors that lead to sexual abuse and provides recommendations for integrating this information into the counseling interaction.     

Beteendeterapi I Danmark

Abstract

This paper examines the rationale used to justify the decision to reduce stereotyped behaviour in people with mental retardation. In general, three assumptions seem to be made in justifying the reduction of stereotyped behaviour. These are that the presence of stereotyped behaviour interferes with the acquisition of new skills, that it may lead to the development of self-injurious behaviour, and that it can have negative social consequences. Each of these assumptions are examined in turn and it is concluded that although evidence can be found to support each, there are frequent exceptions. This suggests that the adoption of a general rule justifying the reduction of stereotypy is inappropriate without first undertaking an individual functional analysis.     

Williams syndrome: a genetic deletion disorder presenting clues to the biology of sociability and clinical challenges of hypersociability

Williams syndrome is a neurodevelopmental disorder that results from the deletion of approximately 25-30 genes spanning about 1.5 megabases in the q11.23 region of chromosome 7. Patients with this syndrome present with a combination of a distinctive elfin-like facial appearance; growth retardation; mild mental retardation; an inconsistent cognitive profile that includes visuospatial impairments with good facial discrimination and relatively preserved expressive language skills; and cardiovascular abnormalities. In addition, a striking behavioral feature of the syndrome is the high sociability and empathy that these patients show for others. The study of patients with "partial" deletions of the chromosome band 7q11.23, mutated genes in this region and knockout mice with deletions of specific genes in the homologous G1-G2 region of mouse chromosome 5 are clarifying some genotype/phenotype relationships. Furthermore, genes located in this region that are prominently expressed have been implicated in brain development and function. The neuropsychological profile of patients with Williams syndrome is heterogeneous, highlights important dissociations between cognitive functions and suggests that the behavioral dimensions of sociability, empathy, engageability, and talkativeness may be independent of, or not easily explained by, the cognitive deficits. Williams syndrome has enormous heuristic value because its pathological feature of heightened "sociability" can be a "deficit" symptom of major complex neuropsychiatric disorders, such as schizophrenia and autism. Data consistent with a core inability of patients with Williams syndrome to inhibit social approach suggest that this disorder may afford an opportunity to study the biological basis of the "drive" toward socialization. From a research perspective, the syndrome lends itself to neurobiological studies of sociability as a dimension that varies independently of cognition (or at least many separable cognitive processes). Importantly, from a clinical perspective, the syndrome challenges us to administer strategic psychosocial interventions that take advantage of the opportunities that "pathological" sociability provide, while avoiding its threats. An illustrative example of an effective strategically planned psychosocial intervention for a patient with Williams syndrome is briefly presented.     

The treatment of dangerous behavior

Individuals who display dangerous behavior towards others have historically been under‐treated and under‐researched. This paper discusses three published case studies wherein adult males were effectively treated for severe aggression towards others, the environment, and, in two cases, self‐injury. All were diagnosed as having mental retardation and two also had a psychiatric diagnosis. All had experienced years of failed attempts to control their aggression through large pharmacological interventions and restricting their freedom of movement via restrictive environments. The use of comprehensive multifaceted behavioral programs involving punishment resulted in dramatic and long lasting reductions in aggression, the elimination or great reduction of drug use, and major lifestyle improvements. The conceptual, clinical, political, legal, philosophical, and ethical considerations that arose during the development and implementation of the programs are discussed as well as scientific issues related to achieving long term maintenance. An early published case study (Martin & Foxx, 1973 ) is discussed first because it illustrates how an informal functional analysis was used to design a very simple and effective non‐punishment treatment program for a woman who displayed dangerous aggression. Copyright © 2003 John Wiley & Sons, Ltd.     

Upward Grounding

Realists about universals face a question about grounding. Are things how they are because they instantiate the universals they do? Or do they instantiate those universals because they are how they are? Take Ebenezer Scrooge. You can say that (i) Scrooge is greedy because he instantiates greediness, or you can say that (ii) Scrooge instantiates greediness because he is greedy. I argue that there is reason to prefer the latter to the former. I develop two arguments for the view. I also respond to some concerns one might have about the view defended. I close by showing that analogous views regarding the truth of propositions (that if the proposition that p is true, then it is true because p) and the existence of facts (that if the fact that p exists, then it exists because p) are supported by analogs of one of these arguments.