Mild Mental Retardation-Related Communication Disorders - Research Paper Example

?Mild Mental Retardation Related Communication Disorders Focused on Children Introduction Mental retardation, in other words, intellectual disability, is a term used for description of intelligence that is below average and impairment of the adaptive functioning of the individual arising during the period of development, from conception to 18 years of age. The term is a challenging one and is often fraught with emotional and social stigma. This term is different from developmental delay which is appropriately used for those individuals less than 5 years of age, who are too young for testing in a formal manner. To establish a diagnosis of mental retardation, the intelligence has to be atleast 2 standard deviations less than the mean intelligent quotient. Mental retardation can be categorized into mild, moderate, severe and profound based on the intelligent quotient and of these, mild mental retardation (MMR) accounts for more than 85 percent of the cases. The intelligent quotient is between 50-55 to 70 and the standard deviation below mean is 2-3. According to Reschly (2009), "MMR was the official designation of a level of MR that involved current intellectual functioning performance between 2 and 3 standard deviations below the population mean and significant limitations in some, but not all, facets of everyday adaptive functioning." The DSM (2005) criteria for mental retardation includes "significantly sub-average intellectual functioning- an IQ of approximately 70 or below, trouble with functioning in multiple areas of life and onset before age 18." Since those with MMR do not have much biological or physical involvement, there is no biological stigmata associated with the diagnosis (Nadelson, 2001). On the other hand, in those with levels of mental retardation beyond MMR, the diagnosis is often made in preschool years and the setting of identification is usually a health care system (Reschly, 2009). The comprehensiveness of the individual is poor and affects performance of the individuals in all social setting and also functional roles. Biological stigmata is always present with the diagnosis (Reschly, 2009). Diagnosis of MMR is often complex and also controversial because of lack of unequivocal symptoms and signs (Hegde and Pomaville, 2008). The diagnosis of MMR was recognized formally about a century ago and has been described in the earlier versions of American Association on Mental Retardation Disabilities (Reschly, 2009). When compared to other levels of mental retardation, MMR is usually not diagnosed until the child attains school age and the diagnosis usually occurs subsequent to referral from the class teacher of the child for suboptimal academic performance. Individuals with MMR typically do not exhibit any physical characteristics, neither do they have much impairment of comprehension (Reschly, 2009). When compared to other levels of mental retardation, MMR is usually not diagnosed until the child attains school age and the diagnosis usually occurs subsequent to referral from the class teacher of the child for suboptimal academic performance. Individuals with MMR typically do not exhibit any physical characteristics, neither do they have much impairment of comprehension (Reschly, 2009). Recent formulations for grading the severity of mental retardation are based on the levels of support needed rather than intelligent quotient. This is because; support levels are anyway related conceptually to impairment levels. Four levels of support are described in this regard and they are analogous to the four levels of impairment used earlier (Reschley, 2009). In this essay, communication problems, their evaluation tools, and treatment will be discussed with reference to MMR. Since there are several causes of MMR and it is beyond the purview of this essay to discuss them, one cause of MMR, the William syndrome will be discussed. Speech and language characteristics of the disorder The permanence in MMR is variable and its identification is unlike during preschool age period and adulthood. Comprehensiveness is affected to some extent, but performance is not affected in all social roles and functional settings (Reschly, 2009). With regard to investigation of the various cognitive processes associated with mental retardation in children and the nature of learning difficulties associated with the condition, experts have found it to be a challenging task. Infact, several theories have come up to explain the various learning disabilities this children with mental retardation suffer from. Some explanations include localized deficits in memory, attention deficits and defects in the processing of information (Dermitzaki, 2008). The strategic behaviour of the student and also the metacognition are prerequisites for adaptive, active and independent learning. Some theorists have even observed self-regulated approach of learning, strategic thinking in situations fraught with problems and self-directed study (Dermitzaki, 2008). Those with mental retardation do not self-regulate and hence cannot use, develop, regulate, monitor, transfer and evaluate strategies when comparted to individuals with appropriate typical development. Some researchers have opined that such difficulties mainly arise because of poor educational achievements, especially when tasks which require language mediation are encountered (Dermitzaki, 2008). There is some evidence that those with MMR do not engage much in activities related to metacognition and that such individuals have poor poor control mechanisms related to metacognition. They also are poor in strategies related to problem solving, planning and monitoring (Dermitzaki, 2008). Dermitzaki et al (2008) conducted a study to investigate strategic behavior in those MMR during problem solving and also to evaluate the relationships between those with ongoing behaviors and also the performance of the students. From the results of the study it was evident that performance with reference to problem solving was on the lower end of the scale in those with MMR. The researchers opined that "further consideration of participants' performance and strategic profiles revealed individual differences within this group of students regarding their performance patterns but also their repertoire of strategic behaviors exhibited." There are several causes of MMR and Williams syndrome is one such cause. In thos condition, microdeletion of 7q11.23 is observed. Williams syndrome is actually a rare condition with prevalence of 0.5 to 1 per 50,000. Other than MMR, William syndrome is associated with several other physical characteristics like typical facies, congenital heart anomalies, connective tissue disorders, growth deficiency and failure to thrive. The cause for MMR is developmental delay. Some patients may have higher degrees of mental retardation. One characteristic feature of this syndrome is the cognitive profile that is specific to the condition which includes verbal short term memory deficits and language problems. The personality profile is also specific and the individuals are empathetic, anxious and over friendly. The language abilities in children with William syndrome are widely studied, explored and subjected to research. There is evidence that these children suffer from language disabilities and the abilities pertaining to language are much below their chronological age and are similar to those with other types of developmental problems. In one report by Bellugi et al (1988; cited in Mervis and Becerra 2007), the researchers opined that those with William syndrome, despite severe mental retardation had excellent language skills. The report projected that adolescents with William syndrome are likely to produce drawings with parts of the drawing scattered over the drawing page in such a manner that the drawing would be identified only when one is told as to what is the subject of drawing. The report further extended to opine that though these individuals can not conserve any quantity or number, they can comprehend or produce any type of linguistic constructions that are complex like conditionals, reversible passives and tag questions. Bellugi et al (1988, cited in Mervis and Becerra, 2007) also opined that those with William syndrome have excellent vocabularies. Based on these facts, the researchers strongly projected that language is different from cognition and they those who are mentally retarded need not necessarily suffer from language disabilities. However, such a statement has been fraught with a lot of criticism and Mervis and Becerra (2007) argue that researchers who claim that language and cognition are independent in William syndrome are those who have not studied the syndrome in a direct sense or are those who have tested the abilities in small sample sizes. After the report by Bellui et al, researchers plunged into enormous research to ascertain language and communication aspects and abilities in those with MMR in cases like Williams syndrome. According to Jakendoff (1994; cited in Mervis and Becerra, 2007) "Williams syndrome individuals almost invariably show mild to moderate mental retardation . . . .Particularly severe deficits show up in tests of spatial understanding such as copying patterns of blocks. Their language, though, is if anything more fluent and advanced than that of their age mates . . .’’ Pinker et al (1999; cited in Mervis and Becerra, 2007) reported that "the genes of one group of children [children who have specific language impairment] impair their grammar while sparing general intelligence; the genes of another group of children [children who have Williams syndrome] impair their intelligence while sparing their grammar’’. In yet another study by Piattelli-Palmarini (2001; cited in Mervis and Becerra, 2007), the researchers opined that "children with Williams syndrome have barely measurable general intelligence and require constant parental care, yet they have an exquisite mastery of syntax and vocabulary. They are, however, unable to understand even the most immediate implications of their admirably constructed sentences’’ (Mervis and Becerra, 2007). Thus, from these reports, it can be deducted that children with William syndrome, despite intellectual impairment may not have any language and communication problems and infact may have excellent vocabulary and syntax. At the same time, a proportion of them may suffer from impaired grammar (Mervis and Becerra, 2007). As far as the modularity position is concerned, while many researchers have not discussed about the modularity perspective, some have opined limited position on modularity, especially with past tense. Some others opine that the range of language ability is wide in those with William syndrome and hence it cannot be generalized in all cases (Mervis and Becerra, 2007). For most children with Williams syndrome, the relative strength is language and clear weakness is visuo-spatial construction. However,m the language ability is not congruent with chronological age. However, it is very rare for an individual with William syndrome to have severe language disability. The concrete vocabulary is at higher level and the conceptual or relational vocabulary is at lower level. Even visuospatial construction is at a similar level. It is also worth mentioning that cognitive abilities and language abilities are actually strongly related. The relationship between grammar and vocabulory, i.e, language and visuospacial ability is actually mediated by verbal working memory and nonverbal reasoning. Gesturing and joint attention, which are early communicative abilities are related to nonverbal reasoning and language abilities and also to visuospacial abilities (Mervis and Becerra, 2007). Evaluation tools and methods With regard to investigation of the various cognitive processes associated with mental retardation in children and the nature of learning difficulties associated with the condition, experts have found it to be a challenging task (Hegde and Pomaville, 2008). Infact, several theories have come up to explain the various learning disabilities this children with mental retardation suffer from. Some explanations include localized deficits in memory, attention deficits and defects in the processing of information (Dermitzaki, 2008). The strategic behavior of the student and also the metacognition are prerequisites for adaptive, active and independent learning. Some theorists have even observed self-regulated approach of learning, strategic thinking in situations fraught with problems and self-directed study (Dermitzaki, 2008). Those with mental retardation do not self-regulate and hence cannot use, develop, regulate, monitor, transfer and evaluate strategies when compared to individuals with appropriate typical development. Some researchers have opined that such difficulties mainly arise because of poor educational achievements, especially when tasks which require language mediation are encountered (Dermitzaki, 2008). The most commonly used measure of general intellectual ability is the Kaufman Brief Intelligence Test (Mervis and Becerra, 2007). The description of general intelligence is actually inaccurate and infact barely measurable. Mervis and Becerra (2007), tested 306 children on this scale and they found that the mean composite intelligence quotient was 69.32. The range was 40- 112. In more than 47 percent of participants, the composite intelligent quotient was atleast 70 or even higher and only 3.6 percent had intelligent quotient levels of 40. The standard deviation in this scale was 15.36 which is similar to the standard deviation in general population. From this it can be said that the distribution of intelligent quotient in those with William syndrome is similar to the general population with the only difference being depression in 2 standard deviations (Mervis and Becerra, 2007). Clinical Evaluation of Language Fundamentals, 4th edition (CELF-4), which was formulated by Semel et al (2003; cited in Mervis and Becerra, 2007) is a useful sentence subtest to ascertain the ability of the child for construction of sentence pertaining to a picture using a target work that is decided by the examiner. The sentences are accepted as correct if they include the provided target word, if they are correct grammatically and semantically and bear some relationship or the other to the picture. In case the sentences contain only one error, they are given partial credit. The scoring is scaled and ranges from 1 to 19. The mean scale is 10 and the standard deviation is 3 (Mervis and Becerra, 2007). The standard test for assessing concrete vocabulary is the Peabody Picture Vocabulory Test. or the PPVT, which basically measures vocabulary of receptive nature with main focus on object names, descriptors and action names. The standard deviation is 13.63 and the expected range is 40- 118 (Mervis and Becerra, 2007). Treatment programs or methods More often than not, children with MMR appear normal during initial years and they acquire normal fine motor and gross motor milestones. However, they exhibit some delay in comprehending verbal concepts and exhibit some immature behavior. During the first 4-6 years of age, they have slow processing of information and appear less capable in coping with challenges pertaining to academics when compared to their peers (Kutscher, 2005). Infact, it is warranted that any such suspicion in any child must lead to psycho-educational testing for determination of appropriate placement of education (Kutscher, 2005). Kaderavek and Rabidoux, (2004) opine that it is very important to focus on literacy during child intervention programs from those with special educational needs and that the final product of such interventions are not emergent literacy or early literacy development, rather what is to be targeted is written or oral language development that is not only reciprocal, but also interrelated. The fact that language ability is not on par with chronological age in those with William syndrome has several implications for interventions for language. This means that most of the children and adolescents with William syndrome are likely to benefit from language therapy. Those who are very young and have significant intellectual disability are likely to benefit from intensive language intervention that focuses on all aspects of language including grammar. For adolescents and older children who have mild disability with reference to intellectual ability, it is very important to target language intervention in specific areas of weakness (Mervis and Becerra, 2007). Patterns of weaknesses and strengths between nonlinguistic cognition, language and within language have important implications for language intervention. One indicator that the child is ready to acquire language is the onset of communicative gestures that are referential. At this stage, the child may be given developmental therapy or language therapy aimed at vocabulary acquisition. It is very important to conduct a full assessment of all aspects of communication and language in order to determine goals pertaining to language therapy. Those who do not have grammatical errors, benefit from therapy aimed at conceptual, relational, pragmatics and figurative language. Other methods of language therapy are music therapy and traditional language therapy but there is no evidence based information in this regard (Mervis and Becerra, 2007). As far as education of an MMR child is concerned, it is very important to have a high degree of individual commitment, constant repetition, patience and willingness to provide emotional support (Kutscher, 2005). The last few years have seen dramatic revolution in the care of MMR children and these children are now cared at home. Various services which are rendered to these children are cognitive therapy, speech therapy, occupational therapy and physical therapy. These therapies are now under the auspices of educational organizations and institutions (Kutscher, 2005). One of the widely practiced educational experiment with regard to those with MMR is inclusion programs in which children with MMR are placed in mainstream classrooms irrespective of their disability and these programs are posed with special challenges both to the student and the teacher (Kutscher, 2005). In the education process, what needs to be emphasized is training with regard to pragmatic life skills. But, one unfortunate thing is that those with MMR rarely are able to be independent completely. "Being able to balance a checkbook, read a tax form, or arrange for a mortgage may be simply beyond their capacities. They will require ongoing support services throughout life, some to a much greater degree than others" (Kutscher, 2005). Personal reaction Children with mild mental retardation are common in speech pathologist clinics and they suffer from a wide range of speech, language and communication problems along with intelligent and cognitive deficits. These children need support and intervention during early stages of development for appropriate and optimal educational tour and also for optimal functioning. Thus, timely diagnosis, identification, intervention, goal setting and training is very important. References Dermitzaki, I., Stavroussi, P., Bandi, M., & Nisitou, L. (2008). Investigating Ongoing Strategic Behaviour of Students with Mild Mental Retardation: Implementation and Relations to performance in a Problem-Solving Situation. Evaluation and Research in Education, 21 (2), 96-100. . Diagnostic and Statistical Manual of Mental disorders. (2005). Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence. Arlington, VA: American Psychiatric Association. Hegde, M.N. & Pomaville, F. (2008). Assessment of Communication Disorders in Children: Resources and Protocols. San Diego, CA: Plural Publishing. Kaderavek, J.N., and Rabidoux, P. (2004). Interactive to Independent Literacy: A Model for Designing Literacy Goals for Children with Atypical Communication. Reading & Writing Quarterly, 20, 237-260. Kutscher, M (2005). Kids in the syndrome mix of ADHD, ID, Asperger’s, Tourettes’s Bipolar, and more! Philadelphia, PA: Jessica Kingsley Publishers. Mervis, C. & Becerra, A. (2007). Language and Communicative Development in Williams Syndrome. Mental Retardation and Developmental Disabilities, 13, 3-15. Nadelson, C. (2001). Disorders First Diagnosed in Childhood. (2001). Encyclopedia of Psychological disorders. Philadelphia, United States of America: Chelsea House Publishers. Reschly, D. (2009). Documenting the Developmental Origins of Mild Mental Retardation. Applied Neuropsychology, 16, 124-134. Read More