Abuse of persons with mental retardation: A literature review

The literature reports a number of reasons why abuse of people with mental retardation occurs. These causes of abusive behavior can be divided into three categories: organizational variables, staff characteristics, and client characteristics. The author examines each of the variables and presents recommendations for reducing their contributions to abusive behavior.     

Relation between self-paced and synchronized movement in persons with mental retardation

The relation between self-paced and synchronized tapping in 64 persons with mental retardation whose mental ages ranged from 2 to 11 years and chronological ages from 13 to 23 years was investigated. In a self-paced tapping task no stimulus was presented, and subjects' easy and spontaneous tapping was measured. In a synchronized tapping task their synchronous tapping with an auditory stimulus present at a quick or slow tempo was measured. Under both tempo conditions, the lower the subjects' mental age, the larger the errors in the intertap interval they made. The subjects of low mental age showed significantly larger errors in the intertap interval in the Slow than in the Quick Tempo condition and tended to tap at a rate near the self-paced tapping. These results may suggest that ability to adjust one's self pace is one of the key factors in the development of motor synchronization in persons with mental retardation.     

Involuntary sterilization of persons with mental retardation: an ethical analysis

Legitimate concerns on the part of parents and guardians may lead to requests for sterilization of a mentally retarded person in their care. At the same time, mentally retarded persons must be protected from actions that do not serve their best interests. This paper will review the history of involuntary sterilization in the United States and evaluate the ethical arguments that are relevant to decisions about involuntary sterilization. While other, less permanent forms of contraception might be acceptable, involuntary sterilization ought not be performed on mentally retarded persons who retain the capacity for reproductive decision-making, the ability to raise a child, or the capacity to provide valid consent to marriage. Mentally retarded persons who lack capacity in those three areas should be considered for involuntary sterilization only when the procedure is necessary, sterilization would serve the best interests of the mentally retarded person, less intrusive and temporary methods of contraception or control of menstruation are not acceptable alternatives, and procedural safeguards have been implemented to assure a fair decision-making process.     

Pupillary responses in recognizing awareness in persons with profound mental retardation

Pupil-size changes have been shown to indicate positive or negative reactions to several sensory and psychologic stimuli in normal persons. Whether this could be extended to mentally retarded patients who lack ability for verbal or motor behavior was tested by pupillary responses to several visual, tactile, and auditory stimuli. 24 institutionalized severely and profoundly retarded patients were examined by video camera in their usual environments rather than in a controlled laboratory setting. The videotapes were later projected onto a screen for pupil-size measurements. Pupils dilated with pleasant stimuli, including visualizing a familiar person, soft touch to the arm, music, and soft compliments. There was constriction with presenting an unfamiliar person, rough grasp of the arm, and abrasive noise and harsh commands. The findings demonstrate the existence of pupil reactivity in profoundly retarded persons and suggest such testing as a means of determining which elements of their environment are pleasing or aversive to them.     

Violence risk assessment in persons with mental illness

Mental health clinicians are often asked to determine an individual's risk of future violence. Dangerous assessments are required in a wide variety of situations that include involuntary commitments, emergency psychiatric evaluations, seclusion and restraint release decisions, inpatient care discharges, probation/parole decisions, death penalty evaluations, domestic violence interventions, fitness for duty evaluations, and after a threat is made. This article provides an overview regarding the assessment of dangerousness in both adults and juveniles and a summary of recent research regarding the relationship of mental illness to violence.     

Making choice a routine part of mealtimes for persons with profound mental retardation

Despite increased recognition of the importance of providing routine choice opportunities for persons with severe handicaps, this population continues to experience a typical lack of such opportunities. We evaluated a program for increasing the amount of choices made during routine mealtimes by persons with profound mental retardation and minimal communication skills. The choice provision program, involving systematic presentation of alternative food and drink items in a step-wise fashion during the course of the meal, was implemented with three persons in a residential facility. Results indicated that after implementation of the choice program, all three participants made consistently more choices concerning the foods and beverages they consumed relative to baseline. The choice provision program was conducted without extending the amount of time typically allotted to mealtime within the residential setting. Results are discussed in regard to additional research needed to continue developing means of assisting persons with profound mental retardation to exert control over meaningful events in their lives.     

Brief report: Non-intrusive operant analysis of aggressive behavior in persons with mental retardation

A procedure for operant analysis of aggressive behavior was derived from multi-element assessment methods that have been previously applied to both self-injurious and stereotypic responding. Analog sessions included No Interaction Baseline, Social Disapproval, Demand, Social Reinforcement, and Discriminated Extinction conditions, repeatedly presented within a multi-element design. Three men with differing severity of mental retardation, communicative deficits and aggressive behavior were exposed to multiple brief analog sessions embedded within their normal meal-time routines in group home settings. Mean frequencies of aggressive behavior and concurrent eating indicate that, while aggressive behavior was negatively reinforced in all three participants, both social and non-social contingencies were also prominent. The same contingencies which have been demonstrated to maintain self-injury and stereotypic behavior can therefore also maintain aggression. Results suggest the feasibility of conducting relatively non-intrusive analog assessments in community residences, and support the-extension of functional analysis across differing classes of aberrant behavior.     

Effects of reinforced directed rehearsal on expressive sign language learning by persons with mental retardation

This study used a multielement design to compare standard training (prompting and reinforcement) with and without reinforced directed rehearsal as a correction procedure in teaching expressive sign language to 10 nonverbal students with moderate to severe mental retardation. Standard training consisted of either sequential prompting or graduated guidance and 5 students were randomly assigned to each condition. Directed rehearsal involved 10 practices of the correct sign contingent on an error or no response; praise was given during directed rehearsal for cooperation and attempted signing. A stimulus control analysis revealed that only 6 of the 10 students (3 from each standard training condition) completely discriminated the trained signs within the maximum training period of 160 trials (3 of the 4 students who failed the stimulus control test were hearing impaired; the remaining 6 who showed stimulus control were not). Using only these six students' data, we found that directed rehearsal increased: (a) accuracy (percent correct), (b) speed of learning (required fewer trials to criterion), (c) efficiency (decreased total instruction time), and (d) generalization (across trainers, objects, and settings). There were no obvious interactions between directed rehearsal and the type of prompting strategy employed. Very little agitated behavior occurred in any of the sessions, and a treatment acceptability survey indicated that 10 of 14 direct-care staff and the trainers in this study preferred corrective directed rehearsal (as used in this study) over standard training alone. The results indicate that directed rehearsal may be a valuable adjunct to sign language training with nonverbal students with mental retardation.     

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).     

Prevalence of severe behavior disorders in persons with mental retardation and treatment procedures used in community and institutional settings

A statewide survey of moderate and severe behavior disorders in persons with mental retardation in institutional and community settings was conducted. Information on the treatment procedures used and the adequacy of available resources in both settings was also gathered. Results indicated that community staff had considerably less experience than institutional staff in dealing with serious behavior disorders exhibited by persons with substantial cognitive and physical impairments. The types of aberrant behaviors with the highest prevalence rates showed differences in the institutions and the community. The largest differences in prevalence rates for severe behavior disorders in the two settings occurred for aggressive and self-injurious behaviors. Community staff thus had appreciably less experience than institutional staff in designing interventions for severe aggressive and self-injurious behaviors. About half of the identified individuals in both settings received psychotropic medications. Institutional staff were most likely to use restrictive behavioral procedures than community staff. Findings indicated that the most restrictive procedures were used primarily with only certain severe behavior disorders. Subjective ratings of the overall effectiveness of interventions were lower by community than institutional staff. The usefulness of the obtained data base for statewide planning in the area of behavioral supports is discussed.     

Ministry and mental retardation

Conclusion This has been an attempt to show how the parents of the mentally retarded inspired me to take a second look at my theological views, to show the method I used, and to give a few instances out of many in which my theological views have been affected. If space had allowed, it would have been good to show how this human predicament can cast new light on our theological thinking about grace, redemption, and many other categories. On the other hand, each of us has a chance to pursue in depth any single doctrine, using the added perspective of this particular crisis situation.Each of us has the original theological perspective which we had before beginning our pastoral involvements with the mentally retarded and their families. Then, as we focus on this human situation we become aware of an added theological perspective that helps us to take a second look from a different viewpoint. We then find our original view has been reinforced, modified, or enlarged. It is my feeling that a pastor who becomes involved with these particular persons-who need his services very much—will find a golden opportunity to grow theologically.If any of us feel we know all we need to know about God and life and man, this would be a good time to become involved in a pastoral way with a mentally retarded person and his family and get to know them well.     

Culture and mental retardation

The Psychological Record -     

An evaluation of in vivo desensitization and video modeling to increase compliance with dental procedures in persons with mental retardation

Fear of dental procedures deters many individuals with mental retardation from accepting dental treatment. This study was conducted to assess the effectiveness of two procedures, in vivo desensitization and video modeling, for increasing compliance with dental procedures in participants with severe or profound mental retardation. Desensitization increased compliance for all 5 participants, whereas video modeling increased compliance for only 1 of 3 participants.     

Verbal and visual instruction with mental retardation: The role of subject characteristics and task factors

Past research and theory presents an inconsistent picture concerning the relative value of verbal versus visual instructional programs for individuals with mental retardation. From an empirical perspective, there is evidence that this inconsistency may be due to the differences in the type of tasks and the specific abilities of the subjects employed across studies. In this research, the effects of three instructional procedures (verbal, visual, and verbal plus visual) were evaluated with mentally retarded persons who varied in verbal and visual ability. Performance was examined on a visual task which incorporated stimuli of varying degrees of familiarity to the subjects. The results indicated that the use of the combined verbal-visual instruction procedure was more effective than the other two training programs when task stimuli were familiar to the subjects. When task stimuli were unfamiliar, instructional procedures which had a visual component were found to be superior to a procedure which employed only the use of verbal component. The subjects' visual ability was most strongly associated with performance outcome when visual instruction was employed and unfamiliar task stimuli were sorted. In contrast, subjects' verbal ability appeared to be equally important across instructional and task conditions. The implications of the results for the design of instructional programs and for future research are discussed.     

The impact of environmental noise on mealtime social interactions in a residential facility for persons with mental retardation

Four levels of environmental noise were experimentally manipulated during lunch and dinner in a residential living unit for 10 behaviorally disordered persons with mental retardation. During the highest noise conditions, there appeared to be some suppression of social interaction between these people, while interaction rates were uniformly higher during softer noise conditions. This effect was evident at both lunch and dinner. Staff members were less affected by the fluctuation in noise levels, although lunchtime staff engaged in more interactions with clients when both the radio and TV were played softly.     

Simple mental addition in children with and without mild mental retardation.

The speeded performance on simple mental addition problems of 6- and 7-year-old children with and without mild mental retardation is modeled from a person perspective and an item perspective. On the person side, it was found that a single cognitive dimension spanned the performance differences between the two ability groups. However, a discontinuity, or "jump," was observed in the performance of the normal ability group on the easier items. On the item side, the addition problems were almost perfectly ordered in difficulty according to their problem size. Differences in difficulty were explained by factors related to the difficulty of executing nonretrieval strategies. All findings were interpreted within the framework of Siegler's (e.g., R. S. Siegler & C. Shipley, 1995) model of children's strategy choices in arithmetic. Models from item response theory were used to test the hypotheses.