Module 12: Mental Retardation (Intellectual Disability)

Intellectually Disabled WomanGeneral Interventions

Children and adolescents with MR require a multidisciplinary intervention approach that takes into account how to optimize functioning in each important area of a particular child’s or teen’s life. With appropriate supports over a sustained period, the life functioning of a person with MR will generally improve.

This section provides primary care providers with interventions that can help children and teens with mental retardation and their families. These interventions are presented in the context of the child or adolescent, family, and community.

Child or Adolescent more information

  • Assess all infants, children, and adolescents for developmental delays at well-child visits. Pay particular attention to concerns parents might express about their child’s or adolescent’s development.
    • Signs of developmental delay in:
      • Infancy
        • Unusual appearance (e.g., dysmorphic features, atypical head circumference)
        • Failure to achieve developmental milestones (e.g., delays in sitting without support, delays in the development of babbling)
      • Early Childhood
        • Not yet walking unassisted (> 18 months)
        • Not yet talking (e.g., speaks fewer than 15 words by 18 months, does not use two-word sentences by age 2)
        • Pronounced lack of self-control (> 3 years)
        • Delayed self-care skills (e.g., feeding, dressing and undressing)
        • Little progress in toilet learning (> 3 years)
      • Middle Childhood and Adolescence
        • Unable to do what is expected at home
        • Forgets things
        • Failing in school
    • Identify areas for further evaluation with screening tools.
Selected Screening Tools

  • Assess and treat the child or adolescent for any associated medical concerns (e.g., seizures, poor visual acuity, or the medical problems associated with Down syndrome).
  • When talking with the child or adolescent, be aware of his level of cognitive development and communication skills. Use developmentally appropriate language to make requests or explain concepts. Language should be as clear and concrete as possible. Avoid leading questions and yes/no questions; children and teens with MR may choose the response they think will please and will often select the last option presented. Check repeatedly to make sure that the child or adolescent understands the questions you are asking.1
  • Consult with a child psychiatrist or developmental behavioral pediatrician about the use of psychopharmacologic agents to help with problems of attention, aggression, anxiety, and mood.
  • Recognize that children and adolescents with MR have strengths and capabilities, aside from their specific adaptive limitations. Help them identify their strengths, and support efforts to enhance these strengths. Focusing on strengths can increase self-esteem.
  • Support children and teens with MR in achieving to the best of their ability. Work with each child or adolescent and family to identify goals and the supports needed to achieve their goals (e.g., classroom assistance, vocational training, transportation assistance). Be aware of the child’s or teen’s developmental needs (e.g., for play and opportunities to make choices in early childhood, for friends and opportunities to make decisions in middle childhood, for increased independence and opportunities to work in adolescence).
  • Recognize that a child or adolescent may need help in sustaining friendships because of communication problems and impairment of age-appropriate self-care and social skills.
  • Help identify year-round group activities in which the child or adolescent can participate.
  • Discuss arranging scheduled activities with supportive peers.
  • Consider activities such as Unified Sports or Special Olympics to help the child or adolescent meet a wider circle of peers, to boost his self esteem, and to offer families an opportunity to network

References

  1. Szymanski, L., & King, B. H. (1999). Practice parameters for the assessment and treatment of children, adolescents, and adults with mental retardation and comorbid mental disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 38 (12 Suppl.), 5S-31S.

Family more information

  • Discuss the diagnosis of a child or adolescent with MR sensitively, honestly, and completely. Identify the child’s or adolescent’s areas of strength, offer emotional support, and provide opportunities for families to express their concerns and ask questions. The family will need to adjust, and they will need to support the child in ways they may not have expected. Help parents express and cope with their feelings and concerns (e.g., sense of loss, adjustment of expectations).
  • Encourage families to engage appropriate supports depending on the age, ability, and interests of their child or adolescent. Regular social, recreational, and physical activities are important for children and teens with MR.
  • Help families implement behavioral management plans to increase their child’s or adolescent’s adaptive behaviors (e.g., meeting household responsibilities) and decrease her maladaptive behaviors (e.g., temper tantrums, emotional lability, disruptive behavior).
  • Counsel families about developmental stages and tasks that may present particular challenges for children or adolescents with MR (e.g., toilet learning, development of friendships, school functioning). As children with MR enter adolescence, help families discuss and address issues such as social relationships, sexuality, increasing independence, and vocational training.
  • Encourage families to work with their child or adolescent on decision-making and safety skills (e.g., learning how to recognize potentially dangerous situations, how to get help, and how to respond to pressure from peers).
  • Work with adolescents and their families to engage supports that improve functioning and to plan for the teen’s transition to adulthood, including the transition to employment and independent living. Provide information on community resources that can help adolescents make this transition (e.g., high school vocational planning programs, local rehabilitative agencies, local chapters of The Arc, an organization of and for people with mental retardation and related developmental disabilities and their families).

Community or School more information

  • Advocate for a comprehensive evaluation of the child’s or adolescent’s cognitive abilities and needs as soon as developmental delays are evident.
  • Children and adolescents with MR are eligible for early intervention and special education services through the Individuals with Disabilities Education Act (IDEA). Offer to participate in the child’s Individualized Family Service Plan (IFSP) (ages 0-3) or Individualized Education Program (IEP) (ages 3 and up). The IEP and IFSP are required under the Individuals with Disabilities Education Act (IDEA), Part B, Assistance for Education of All Children with Disabilities, and Part C, Infants and Toddlers with Disabilities, respectively. The IFSP and IEP document the child’s (and family’s in the case of the IFSP) current level of functioning, establish goals, and delineate the services needed to meet those goals.
  • The child or adolescent may also qualify for services under Section 504 of the Rehabilitation Act.
  • Direct families that desire more information to contact:
    • Their school’s special education coordinator
    • The local school district
    • The state department of education’s special education division
    • The U.S. Department of Education’s Office of Special Education Programs
    • The Individuals with Disabilities Education Act (IDEA) 2004 Web site
    • The U.S. Justice Department’s Civil Rights Division
  • Pay special attention to the child’s or adolescent’s language abilities and level of social maturity when helping families and schools assess options for academic placement.
  • Encourage parents to develop an educational plan that allows the child or adolescent to develop strengths and interests (e.g., expressive vocabulary, visual memory, music, art).
  • Continue to be available to children and teens with MR and their families to support and advocate for the child’s or adolescent’s academic and vocational needs as she progresses through school. Focus on interventions that can help maximize the child’s or teen’s scholastic achievement and adaptive functioning (e.g., person-centered planning, postsecondary transition services, vocational training).1, 2, 3

References

  1. National Center on Secondary Education and Transition. (2004, February). Person centered planning: A tool for transition. Parent Brief: Promoting Effective Parent Involvement in Secondary Education and Transition, pp. 1-8.
  2. Grigal, M., Dwyre, A., & Davis, H. (2006, December). Transition services for students aged 18-21 with intellectual disabilities in college and community settings: Models and implications of success. Information Brief: Addressing Trends and Developments in Secondary Education, 5 (5), pp. 1-5.
  3. Luecking, R., & Gramlich, M. (2003, September). Quality work-based learning and postschool employment success. Issue Brief: Examining Current Challenges in Secondary Education and Transition, 2 (2), pp. 1-6.
Resources for Providers and Families

For Providers

For Families

Copyright Georgetown University Georgtown University Mental Retardation