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.     

Standard Score Analysis: Interpretive software for aiding mental retardation identification

Federal and most state guidelines mandate mental retardation identification based on intelligence and adaptive behavior scores. This paper describes Standard Score Analysis: Mental Retardation (SSA: MR), a computer program that interprets IQ and adaptive behavior scores according to cutoff values, measurement error, and IQ-adaptive behavior correlations. SSA: MR yields probabilities that each score is below its respective cutoff, and that IQ and adaptive behavior scores are simultaneously below cutoffs.     

The epidemiology of mental retardation: challenges and opportunities in the new millennium

There are a number of problems and challenges in relating the science of epidemiology to mental retardation (MR). These relate to how MR is defined and classified and how these definitions may change over time. These as well as other differences in ascertainment sources and methods need to be considered when comparing MR prevalence over time and place. On the other hand, advances in technology also provide new and efficient methods of data collection both by data linkage and by use of web-based methods to study rare diseases. While prevalence studies have not been individually reviewed, we have examined the range of data including recent studies relating to how prevalence differs according to age, gender, social class and ethnicity. Some problems with available etiological classification systems have been identified. Recent etiological studies, most of which use different classification systems, have been reviewed and explanations have been postulated to account for differences in results. Individual risk factors for MR are considered whilst the option of considering a population as opposed to a high risk strategy to MR prevention is raised. This might well involve improving the social milieu surrounding the occurrence of individual risk factors. The impact of biotechnological advances such as antenatal and neonatal screening and assisted reproduction on MR are discussed. The issue of how inequalities in access to technology may impact on case identification and even have the potential to further widen inequalities is raised. The importance of extending the use of epidemiological tools to study the social, health and economic burden of MR is also emphasized. However, in order to apply to MR the "prevention-intervention-research" cycle, which surely underpins all epidemiology, it is vital to ensure that the methodological challenges we raise are adequately addressed.     

Predicting preschool screening referral rates from district demographic data

The ability of social, economic, and educational variables to predict screening referral rates among 398 school districts in a statewide preschool screening program was examined. First, salient demographic and educational variables were identified and reduced to five global factors by principal (common) factor analysis. Then, five factor scores and one additional variable (percentage of handicapped students) for each school district were evaluated as predictors of two screening outcomes. In Study 1 the screening outcome was membership in groups of screening programs with the lowest versus highest referral rates. In Study 2 the screening outcome was referral rates among the screening programs. The results from both studies indicated that screening referral rates were not related to broad social, economic, and educational factors in any simple way. Alternative explanations are discussed, as well as implications for research on factors that may influence the screening of preschoolers.     

Pediatrician Identification of Child Behavior Problems: The Roles of Parenting Factors and Cross-Practice Differences

While most primary care pediatricians acknowledge the importance of identifying child behavior problems, fewer than 2% of children with a diagnosable psychological disorder are referred for mental health care in any given year. The present study examined the potential role of parental characteristics (parental affect, parenting style, and parenting self-efficacy) in pediatrician identification of child behavior problems, and determined whether these relationships differed across practices. Parents of 831 children between 2 and 16 years completed questionnaires regarding demographic information, their child’s behavior, their affect, their parenting style, and their parenting self-efficacy. Pediatricians completed a brief questionnaire following visits in four community-based primary care practices in the Midwest. Logistic regressions controlling for child behavior and demographic predictors of pediatrician identification found that an authoritarian parenting style, in which parents yell or strongly negatively react to problem behavior, was negatively associated with likelihood of identification in the overall sample. However, the variables that were predictive of pediatrician identification differed depending on the specific practice. Parental characteristics can aid in understanding which children are likely to be identified by their pediatrician as having behavioral problems. The finding that practices differed on which variables were associated with pediatrician identification suggests the need to potentially individualize interventions to certain physicians and practices to improve identification of child behavior problems in primary care.     

Caregiver Factors Predicting Service Utilization Among Youth Participating in a School-based Mental Health Intervention

Large numbers of children and adolescents experience diagnosable psychiatric disturbances; however, the majority of those with need do not utilize mental health services. Characteristics of caregivers are important predictors of which youth will access and continue to use services over time. In recent years school-based mental health intervention programs have played a key role in identifying youth with mental health needs and linking them to treatment. In this study we sought to identify the caregiver demographic and contextual factors that predict days of service use among youth participating in a school-based mental health intervention program. Our sample included 85 youth ages 5–18 and their caregivers. We analyzed the data using bivariate and multivariate Poisson regressions with caregiver factors as the independent variables and days of service as the dependant variable. We found significant bivariate and multivariate associations for every caregiver demographic (sex, age, race) and contextual (education, employment, income, insurance, health, strain, and was it the caregivers idea to seek treatment) factor that was examined. In this study we identified the caregiver factors that are likely important in predicting youth service utilization even when steps have been taken to improve identification and access.     

Can defendants with mental retardation successfully fake their performance on a test of competence to stand trial?

The purpose of this study was to determine whether criminal defendants with mental retardation can feign poor performance on a test of competence to stand trial. Four groups of adjudicated criminal defendants were given a test of competence to stand trial. In the experimental condition, defendants with mental retardation (MR) and mentally typical defendants (non-MR) were given instructions to fake their performance on the test. In the control, MR defendants and non-MR defendants took the test under standard conditions. The results indicated that both the MR and non-MR fakers scored significantly lower than the MR and non-MR controls. There was no significant difference in the scores of the MR and non-MR fakers. The results suggest that defendants with mental retardation may be able to successfully fake their performance in certain circumstances. Implications of these findings are discussed.     

弱智儿童在上课时和自由活动时的行为表现

研究了４１名弱智儿童。采用时间样本的方法收集材料,以期从动态角度了解弱智儿童在上课时和自由活动时的行为表现。按园别和智力落后程度两个方面对被试在上课时的８大类行为和自由活动时的７大类行为进行了分析。结果发现：班级人数、不同教学方法和智力落后程度与弱智儿童的行为表现有关。还对收集材料的方法、园别和智力落后程度与弱智儿童的行为表现的关系、高频率的自娱活动等,进行了讨论。最后,根据研究结果对教师提出了教学建议。     

中学生感觉寻求、亲子关系与心理健康的关系

以370名中学生为被试,采用量表法,考察了中学生感觉寻求、亲子关系(家庭教养方式)与心理健康水平的关系。结果表明:(1)人口统计学变量(性别、是否单亲、年级和家庭人均月收入)对中学生心理健康水平具有显著影响。(2)去抑制感觉寻求因子和亲子关系与心理健康水平相关显著:去抑制与心理健康呈显著正相关,亲子关系与心理健康呈显著负相关,去抑制与亲子关系呈显著负相关。(3)在控制了人口统计学变量之后,去抑制感觉寻求因子和消极拒绝型、积极拒绝型、不安型、矛盾型亲子关系对心理健康水平具有良好预测能力。(4)去抑制感觉寻求因子在亲子关系对心理健康的影响上起到了中介作用。     

Mental retardation genes in drosophila: New approaches to understanding and treating developmental brain disorders

Drosophila melanogaster is emerging as a valuable genetic model system for the study of mental retardation (MR). MR genes are remarkably similar between humans and fruit flies. Cognitive behavioral assays can detect reductions in learning and memory in flies with mutations in MR genes. Neuroanatomical methods, including some at single-neuron resolution, are helping to reveal the cellular bases of faulty brain development caused by MR gene mutations. Drosophila fragile X mental retardation 1 (dfmr1) is the fly counterpart of the human gene whose malfunction causes fragile X syndrome. Research on the fly gene is leading the field in molecular mechanisms of the gene product's biological function and in pharmacological rescue of brain and behavioral phenotypes. Future work holds the promise of using genetic pathway analysis and primary neuronal culture methods in Drosophila as tools for drug discovery for a wide range of MR and related disorders.     

Predictors of violence exposure among inner-city youth

Examined the ability of demographic variables and risk factors (parental substance use, number of people in the home, out-of-home placements, grades repeated, arrest history, and total life stress) to predict exposure to community violence among 342 high school students from inner-city Baltimore referred for mental health care in community centers or in the schools. Over 90% of the sample knew at least 1 victim of a violent act, 77% reported witnessing a violent act, and 47% reported past victimization by violence. Risk variables were more powerful regression predictors of violence exposure than demographic characteristics such as race, sex, or clinical setting. Even after controlling for demographic differences in violence exposure, risk factors as a group accounted for another 10% to 15% of variance. Life stress was the most consistent predictor of violence exposure for this sample, and life stress was the only variable to make a significant unique contribution to the prediction of all 4 violence criteria.     

The abilities of children with mental retardation to remember personal experiences: implications for testimony

Investigated the abilities of children with mental retardation to remember the details of a personally experienced event. A simulated health check was administered to 20 children with mental retardation and 40 normally developing children, half matched on mental age (MA) and half matched on chronological age (CA) with the children with mental retardation. The children's memory was assessed immediately after the health check and 6 weeks later. Overall, the children with mental retardation accurately recalled the health check features, provided detail, and resisted misleading questions about features that did not occur. The group with mental retardation performed similarly to the MA matches on virtually all of the memory variables. The children with mental retardation performed worse than the CA matches on most of the memory variables, although they were able to recall a similar number of features. The findings are discussed in terms of the ability of children with mental retardation to provide accurate testimony.     

Narrow and broad definition of mixed-handedness in male psychiatric patients.

Differences in assessment and classification procedures of many mixed-handedness studies have made comparison of findings difficult. In the present study, "narrow" and "broad" definitions of mixed-handedness were investigated using the Annett Handedness Questionnaire in patients with schizophrenia (n=68), panic disorder (n=62), borderline personality disorder (n=35), heroin addiction (n=54), and mental retardation (n=33) in comparison with 944 controls. According to the "narrow" definition of mixed-handedness, an excess of mixed-handedness was observed in patients with borderline personality disorder and mental retardation. An excess of nonmixed-handedness was found in patients with panic disorder. According to the "broad" definition of mixed-handedness, an excess of mixed-handedness was observed in patients with mental retardation, in the total sample of psychiatric patients (n=252), and in the schizophrenic patients. Thus, we can conclude that different mixed-handedness definitions can be associated with different results. Furthermore, we suggest that the neurotic part of the present psychopathology spectrum tends to be related to an excess of normal or nonmixed-handedness, and the psychotic as well as the organic portion is associated with an excess of mixed-handedness, regardless of the definition of mixed-handedness used.     

Attributional Style and Personality as Predictors of Happiness and Mental Health

This paper contains two studies which set out to examine to what extent attributional style (internal, stable, global) and personality traits predicted happiness and psychiatric symptoms in a normal, non-clinical, population of young people in their early twenties. Two hundred and three participants completed five questionnaires: the Attributional Style Questionnaire (ASQ) (version one & version two), Eysenck Personality Questionnaire, Oxford Happiness Inventory, and Langner 22-Item Measure. Sample 1 (n = 120) completed ASQ version one (in both positive and negative situations) and sample 2 (n = 83) completed ASQ version two (in expanded negative situations). Regressional analysis showed that ASQ (in both versions) was the significant predictor of happiness and mental health accounting for 20% to 38% of variances. The ASQ was significantly associated with extraversion and neuroticism. Further, with happiness and mental health as dependent variables and attributional style, personality traits, and demographic variables as independent variables respectively, extraversion and attributional stability (in positive situations) were the significant predictors of happiness accounting for 59% of the total variance whilst neuroticism and psychoticism were the significant predictors of mental health accounting for 53% of the total variance. The results indicated that optimistic attributional style in positive situations was a stronger predictor of self-reported happiness than mental health and pessimistic attributional style in negative situations was a predictor of both happiness and mental health. Extraverts tended to have optimistic explanatory style for positive outcomes whereas neurotics tended to have pessimistic explanatory style for negative outcomes.     

Self‐Stigma,Mental Health Literacy,and Attitudes Toward Seeking Psychological Help

This study examined self‐stigma of seeking psychological help and mental health literacy as predictors of college students’ (N = 1,535) help‐seeking attitudes, with additional attention to psychological and demographic correlates. Results indicated that mental health literacy predicted help‐seeking attitudes above and beyond self‐stigma. Asian American race/ethnicity, male gender, current psychological distress, and help‐seeking history were also significant predictors. Implications for addressing mental health literacy and self‐stigma while attending to demographic and psychological variations in help seeking are discussed.     

The Glory of God is a Human Being Fully Alive: Predictors of Positive Versus Negative Mental Health Among Clergy

Clergy fulfill vital societal functions as meaning makers and community builders. Partly because of their important roles, clergy frequently encounter stressful situations. Further, studies suggest that clergy experience high rates of depression. Despite this, few studies have examined protective factors for clergy that may increase their positive mental health. We invited all United Methodist clergy in North Carolina to participate in a survey. Of church‐serving clergy, 85 percent responded (n = 1,476). Hierarchical multiple regression was used to assess the predictors of three positive and four negative mental health outcomes. The three sets of predictors were: demographics, which explained 2–10 percent of the variances; variables typically related to mental health (social support, social isolation, and financial stress), which explained 14–41 percent of the variances; and clergy‐specific variables, which explained 14–20 percent of the variances, indicating the importance of measuring occupation‐specific variables. Some variables (e.g., congregation demands) significantly related to both positive and negative mental health, whereas others (e.g., positive congregations, congregation support) significantly related primarily to positive mental health. In addition to their intervention implications, these findings support separate consideration for negative versus positive mental health.     

Effects on fathers of children with down syndrome

This study investigated research evidence for eight assertions found in the literature about effects on fathers of children with disabilities. Eighty-seven fathers of children with Down syndrome completed questionnaire instruments designed to measure demographic variables, adaptation, stress, personality, social support and marital functioning. The results provided little support for most of the assertions. It is concluded that the existing literature provides a somewhat erroneous perspective of the experiences of such fathers. These findings reinforce the need for further research specifically with fathers of children with mental retardation.     

Loneliness and mental health in a representative sample of community-dwelling Spanish older adults

Research seems to support loneliness as a risk factor for mental health problems in the elderly. Most studies analyzing the effects of loneliness on older adults' mental health have relied on convenience samples. In this study, the prevalence and predictors of feelings of loneliness were studied in a representative sample of 272 community-dwelling Spanish older adults. The potential of feelings of loneliness to significantly contribute to the explanation of mental health of the elderly was also explored. The percentage of people reporting feelings of loneliness was 23.1%. Being a woman, being older, living alone, having fewer economic resources, having lower perceived health, and being dissatisfied with the frequency of contact with relatives and friends were found to be significant predictors of feelings of loneliness. Loneliness contributed significantly to the explanation of mental health, even when other significant variables were statistically controlled. The results of this study suggest that loneliness is a relevant factor for the analysis and understanding of mental health in the elderly.     

Medical burden, cerebrovascular disease, and cognitive impairment in geriatric depression: modeling the relationships with the CART analysis

Herein, the background information reflecting roles of medical burden, cerebrovascular disease and risk factors, and cognitive impairment in geriatric depression are reviewed. The authors then propose a nonparametric statistical approach to the data analysis of multiple putative causal variables for late-life depression, the Classification and Regression Tree Analysis. This analysis presents a useful approach to modeling nonlinear relationships and interactions among variables measuring physical and mental health, as well as magnetic resonance imaging and cognitive measures in depressed elderly. This method uncovers the existing interactions among multiple predictor variables, and provide thresholds for each variable, at which its predictive power becomes statistically significant. It presents a "hierarchy" of the predictors in a form of a decision tree by finding the best combination of predictors of an outcome. The authors present two models based on demographic variables, measures of vascular and nonvascular medical burden, neuroimaging indices, the Mini-Mental State Examination score, and neuropsychological test scores of 81 elderly depressed subjects. Cognitive tests of verbal fluency and executive function are identified as the best predictors of depression, followed by the frontal lobe volume and Mini-Mental State Examination. The authors observed that an interaction between frontal lobe volume, total lesion volume, and medical burden was predictive of depression.     

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).