Alcohol affects teens differently from adults. While adults tend to get more subdued and slowed down by alcohol, in adolescents it’s the opposite. They tend to become more energetic, engage in more risky behaviour and get more aggressive. Dr. Taskiran uses the example of driving. “When adults drink and drive you worry about slowing of the reflexes and lapses in attention, like missing a stop sign,” he explains. “But with adolescents, we’re worried that they’re going to get more activated. It’s not that they won’t see the red light, but they might try to run it.” This is especially dangerous for kids with ADHD, who are already impulsive. And substance use makes depressed teenagers more prone to impulsive suicidal behaviour. “The adolescent will still be depressed,” says Dr. Taskiran, “but the things that usually hold him back won’t be there while he’s intoxicated, like love for family or the belief that he’s going to get better.” Why teenagers get addicted sooner? Adolescent alcohol or drug use accelerates very quickly when an untreated mental health disorder is present. ”Within months we can see problematic use,” says Dr. Taskiran. Why are they different than adults? In the adolescent brain, pathways between regions are still developing. This is why teens learn new things quickly. This “plasticity” means the brain easily habituates to drugs and alcohol. “If you start drinking at 30, you don’t get addicted nearly as fast as if you start drinking at 15,” adds Ms. Friedman. Alcohol and drugs also affect the same brain regions that are at play in behaviour disorders like ADHD and ODD, says Dr. Taskiran. Teenagers who have those disorders get more satisfaction from the substance — and are more likely to become addicted. “Biologically they get more from the drug,” he adds, “so that’s why they get more hooked on it.” It’s important to know that substance use can have disrupt a young person’s life even if he is not technically dependent on the drug. This is especially true for youth with mental health disorders. “You might not see withdrawal, you might not see the craving, which are the hallmark symptoms for dependence,” says Dr. Taskiran. “But the impact in his social life and academic life, or in terms of his mental wellbeing, might still be large.” Why substance use makes depression and anxiety worse “Self-medicating” with recreational drugs and alcohol works temporarily to alleviate symptoms of anxiety or depression because they affect the same brain regions that the disorders do. But the result is that teens feel even worse when not using. That’s one reason substance use is a risk factor for suicide in kids with depression, Dr. Taskiran notes. Another negative effect of substance use is that it undermines treatment. First, it diminishes a teenager’s engagement in therapy, and hence its effectiveness. Second, if she is taking 51 CU IDOL SELF LEARNING MATERIAL (SLM)
prescription medication, it may lower the effectiveness of that medication. “The drugs and the medications target the same areas of the brain,” explains Dr. Taskiran. When meds have to compete with drugs or alcohol, they are less effective. “Also, it’s not uncommon with kids who are using substances to be noncompliant with their meds.” What Psychological Factors Contribute to Mental Illness? Psychological factors that may contribute to mental illness include: • Severe psychological trauma suffered as a child, such as emotional, physical, or sexual abuse Emotional and psychological trauma is the result of extraordinarily stressful events that shatter your sense of security, making you feel helpless in a dangerous world. Psychological trauma can leave you struggling with upsetting emotions, memories, and anxiety that won't go away. • An important early loss, such as the loss of a parent A bereaved child or young person will probably display mood swings and may display behaviours that appear polar to the behaviours of the child / young person prior to their bereavement. For example, a previously gregarious and popular pupil might become sullen and withdrawn following the death of someone close. • Neglect Neglect is the failure to provide for or meet a child’s basic physical, emotional, educational, and medical needs. Parents or caregivers may leave a child in the care of a person who is known to be abusive, or they may leave a young child unattended. There are many forms of neglect. In physical neglect, parents or caregivers may fail to provide adequate food, clothing, shelter, supervision, and protection from potential harm. In emotional neglect, parents or caregivers may fail to provide affection or love or other kinds of emotional support. Children may be ignored or rejected or prevented from interacting with other children or adults. In medical neglect, parents or caregivers may not obtain appropriate care for the child, such as needed treatment for injuries or physical or mental health disorders. Parents may delay obtaining medical care when the child is ill, putting the child at risk of more severe illness and even death. 52 CU IDOL SELF LEARNING MATERIAL (SLM)
In educational neglect, parents or caregivers may not enrol the child in school or may not make sure the child attends school in a conventional setting, such as a public or private school, or in their home. Neglect differs from abuse in that usual parents and caregivers do not intentionally mean to harm children in their care. Neglect usually results from a combination of factors such as poor parenting, poor stress- coping skills, unsupportive family systems, and stressful life circumstances. Neglect often occurs in poor families experiencing financial and environmental stresses, particularly those in which parents also have untreated mental health disorders (typically depression, bipolar disorder, or schizophrenia), use drugs or have an alcohol use disorder, or have limited intellectual capacity. Children in single-parent families may be at risk of neglect due to a lower income and fewer available resources. • Poor ability to relate to others Children and adolescents can show weaknesses in social skills due to a variety of factors, and deficiencies can become more apparent as children age and social landscapes become more complex. Weak social skills are commonly found in children diagnosed with Attention- Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), Non-verbal Learning Disability (NVLD), and Social Communication Disorder (SCD). Environmental factors, past failures, anxiety, or depression can also play a role for some children. Symptoms seen in children with weak social skills can include difficulty in any or all of the following three steps involved in social interaction. Perception: • Doesn’t understand facial expressions or body language • Is a poor listener and loses the point of what is being said • Has little interest in social interactions • Not noticing rejection actions by others Interpretation: • Is overly literal and doesn’t get sarcasm • Doesn’t know how to properly greet people, request information, or gain attention • Has difficulty with perspective taking Response: • Shares information in inappropriate ways 53 • Interrupts or blurts out answers • Constantly moves around and fidgets CU IDOL SELF LEARNING MATERIAL (SLM)
• Goes off-topic or monopolizes conversations • Doesn’t adapt language to different situations or people What Environmental Factors Contribute to Mental Illness? Certain stressors can trigger an illness in a person who is susceptible to mental illness. These stressors include: • Death or divorce Research has documented that parental divorce/separation is associated with an increased risk for child and adolescent adjustment problems, including academic difficulties (e.g., lower grades and school dropout), disruptive behaviours (e.g., conduct and substance use problems), and depressed mood. Offspring of divorced/separated parents are also more likely to engage in risky sexual behaviour, live in poverty, and experience their own family instability. Risk typically increases by a factor between 1.5 and 2. Still, most children whose parents divorce are resilient and exhibit no obvious psychological problems. It is important to recognize, however, that even resilient young people from divorced families often report painful feelings or encounters, such as worrying about events like graduations or weddings when both parents will be present. • A dysfunctional family life Dysfunctional families have several characteristics in common, which showcase the unfortunate dynamics between family members, and their attitude towards each other. Growing up in a dysfunctional family can largely have negative effects on the children in the family. Mistrust, anxiety, despise, and other negative emotions lead to the making of a very insecure adult. Certain common behaviour patterns can be observed in people who come from a dysfunctional family, such as: 1. They have a bad image of themselves, and they suffer from low self-confidence and self-esteem. 2. They find it difficult to form healthy adult relationships, and are shy or have a personality disorder. 3. They get angry frequently and easily, and prefer to be in isolation. 4. Their academic performance is usually poor, as they struggle to concentrate and focus. 5. They exhibit self-harm or self-destructive behaviour. 6. They are prone to addiction to alcohol, drugs, or smoking. 54 CU IDOL SELF LEARNING MATERIAL (SLM)
7. They can suffer from mental health issues such as depression, suicidal thoughts, anxiety, paranoia, etc. 8. They may lack discipline due to lack of a role model to look up to while growing up, and can become irresponsible or destructive. 9. They can also lose their childlike qualities of innocence, as they have to take major responsibilities at an early age. • Feelings of inadequacy, low self-esteem, anxiety, anger, or loneliness Inadequacy—not being good enough—is experienced by everyone at one point or another. But when feelings of inadequacy—low self-worth, incompetence, powerlessness, and even shame—begin to interfere with the ability to maintain relationships, succeed at work or in school, or feel happy and at peace, exploring the underlying issues that incite those feelings may help. There are many events in life that can contribute to feelings of inadequacy, from childhood neglect to workplace harassment. Most often, feelings of inadequacy are rooted in childhood experiences, like having had overly critical parents, cruel peers, shaming authority figures, or, perhaps, having not had opportunities to engage in positive, challenging experiences that help children gain feelings of competence and adequacy. Mental health conditions like depression, anxiety, co-dependency, and posttraumatic stress can also contribute to feelings of inadequacy. In adulthood, workplace harassment or bullying can undermine an individual’s self- confidence and cause that person to begin to doubt his or her worth and abilities. Parenting, too, can produce feelings of inadequacy as many parents struggle with feeling like they cannot adequately provide for their children financially, emotionally, or physically. Those parents who were made to feel inadequate when they were children may set unrealistic goals for themselves in their role as parents, thus perpetuating feelings of inadequacy as they fail to meet those high standards. Feelings of inadequacy may also be triggered or worsened by messages in the prevailing culture, particularly in the media, promoting standards of beauty, strength, fame, power, and wealth that are impossible for most people to attain. We may see other people as happy, successful, empowered, and good, and when we compare this image with our own perceived failings, we feel inadequate. In reality, we have no idea what really goes on in most other people’s lives and minds, and we often overlook our own strengths and successes, so such comparisons are bound to do far more harm than good. • Changing jobs or schools 55 CU IDOL SELF LEARNING MATERIAL (SLM)
Whenever possible, keep your child at the same school or a school in the same district. Research has found that moving schools can be particularly difficult for children in the elementary and middle school years. If your child has previously fallen behind academically, moving to a more advanced curriculum may overwhelm them—or even cause them to fall further behind. For a child, academic failure can be devastating to self-esteem. Low self-esteem is common among depressed children. Changing schools may have lasting effects on children. Research has found that kids who moved frequently have fewer quality relationships as adults. They also tend to have less life satisfaction and lower overall well-being. Children who have had previous mental health concerns, especially depression, are more likely to have another period of depression. Research suggests that moving is a significant life stressor for children. Moving schools can be as traumatic as having a parent hospitalized for a serious medical illness. Some children, especially those with a past mental illness, are prone to depression as a result of stress. Be on alert for signs and symptoms and consider speaking with your child's therapist about a care plan before you leave. You may also want to ask for a referral to a new provider in your new town. • Social or cultural expectations What comes to mind when you think about culture? For a lot of us, we immediately think of what’s right in front of us: unique languages, different clothing, and diverse food. But a society’s culture also impacts a person’s beliefs, norms, and values. It impacts how you view certain ideas or behaviours. And in the case of mental health, it can impact whether or not you seek help, what type of help you seek and what support you have around you. It’s important that we understand the role culture plays in mental health care so we can support our loved ones and encourage treatment when it’s needed most. Here are four ways culture can impact mental health: 1. Cultural stigma. Every culture has a different way of looking at mental health. For many, there is growing stigma around mental health, and mental health challenges are considered a weakness and something to hide. This can make it harder for those struggling to talk openly and ask for help. 2. Understanding symptoms. Culture can influence how people describe and feel about their symptoms. It can affect whether someone chooses to recognize and talk about only physical symptoms, only emotional symptoms, or both. 56 CU IDOL SELF LEARNING MATERIAL (SLM)
3. Community Support. Cultural factors can determine how much support someone gets from their family and community when it comes to mental health. Because of existing stigma, minorities are sometimes left to find mental health treatment and support alone. • Substance abuse by the person or the person's parents Children who grow up in a home with parental drug use often suffer from a variety of emotional and developmental delays. Parental drug use and child neglect are common co- occurring conditions within families. Children who grow up in a home with parents who are addicted to drugs or alcohol are three times more likely to suffer physical, sexual, and emotional abuse. Whether it is at the hands of a parent who is using drugs or alcohol or due to exposure to others who abuse them, kids whose parent’s abuse substances are at greater risk. The lasting traumatic effects of these types of abuse can be devastating throughout the lifespan. These kids are also four times more likely to experience neglect than their peers in non-substance abusing homes. When drugs and alcohol become the priority, parents begin to lose focus on their role and how important it is to be physically and emotionally available to their children. Parents in these situations often feel incredibly guilty and ashamed of their addiction, and these feelings contribute to more substance abuse to mask the guilt and shame. It is a cyclical pattern that, when combined with the physical aspects of addiction, can keep people stuck. The emotional impact of substance abuse is severe, as children learn their needs are no longer a priority. Neglect has lasting effects on children emotionally and can even have physiological side effects and negative health outcomes. Often behavioural and emotional problems arise in children who live in homes with addicted parents; this may mean angry outbursts, depression, anxiety, or detachment. It is difficult for children to articulate what they are feeling and thinking, and as a result, their behaviours are usually the best indicator of their emotional state. When children grow up in an environment in which neglect is the norm and substance abuse is the priority, their mental and physical wellbeing suffers and their ability to have a healthy attachment to other people is compromised. Kids in this situation are more likely to repeat these patterns in their own lives and it becomes an intergenerational problem. When children are being neglected due to parental substance abuse, developmental problems often arise, such as speech delays, malnutrition, and cognitive functioning issues. Parental drug use during pregnancy can result in birth defects, attachment problems and drug-affected new-borns. These are major health issues that can shorten children’s lifespan and the ability to learn and function. Substance abuse’s impact on children is severe and often irreversible. Parents certainly don’t set out with a plan to become addicted, but often become more involved with substance use due to the physically addictive properties of drugs and alcohol. Casual use of substances can easily turn addictive. Parents who abuse drugs and alcohol run 57 CU IDOL SELF LEARNING MATERIAL (SLM)
the risk of addiction, particularly if there is a genetic predisposition and co-occurring mental health issues. 2.5 SUMMARY • We have described a developmental–systems framework for child psychopathology that emphasizes three central themes. • The need to study child psychopathology in relation to ongoing normal and pathological developmental processes; • The importance of context in determining the expression and outcome of childhood disorders; • The role of multiple and interacting events and processes in shaping both adaptive and maladaptive development. • The research findings presented in the subsequent chapters of this volume illustrate the importance of these themes for understanding children and adolescents displaying a wide range of problems and/ or disorders. • A developmental–systems framework eschews simple linear models of causality and advocates for a greater emphasis on systemic and developmental factors and their interactions in understanding child psychopathology. • Multiple etiologies and their interplay represent the norm for most forms of child psychopathology. • However, many of these influences have also been implicated in other disorders, and not all children who exhibit such risks develop conduct disorder. There is a need for research that will help to disentangle the role of these multiple sources of influence and their interactions in relation to different childhood disorders. • We have argued that all forms of child psychopathology are best conceptualized in terms of developmental trajectories, rather than as static entities, and that the expression and outcome for any problem will depend on the configuration and timing of a host of surrounding circumstances that include events both within and outside a child. • For any dynamically changing developmental trajectory, there also exists some degree of continuity and stability in structure, process, and function across time. • Understanding such continuity and stability in the context of change represents a challenge for future research; it necessitates that psychopathology in children be studied over time, from a number of different vantage points, utilizing multiple methods, and drawing on knowledge from a variety of different disciplines. • Given the complexities associated with a developmental–systems framework for understanding child psychopathology, there is a clear need for theories to guide our research efforts. 58 CU IDOL SELF LEARNING MATERIAL (SLM)
• We have argued that a developmental psychopathology perspective provides a broad macro paradigm for conceptualizing and understanding childhood disorders in general, and that complementary disorder- and problem-specific theories are also needed to account for the specific configurations of variables commonly associated with particular disorders. • Such problem-specific theories are presented in the subsequent chapters of this volume. The conceptualization of child psychopathology in terms of developmental trajectories, multiple influences, probabilistic relationships, and diverse outcomes suggests that some influences are likely to be common to many different disorders and that others are probably specific to particular problems. 2.6 KEYWORDS • Adolescence: transitional phase of growth and development between childhood and adulthood. • chronic illness is a long-term health condition that may not have a cure. Examples of chronic illnesses are: Alzheimer disease and dementia. Arthritis. Asthma • Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders • Neurochemical : It is alterations resulting due to endocrine changes or exposure to some drug often tilt the fine balance of nervous system functioning and have been observed even in mood changes, depression and neurological diseases of significance. • Autism: it is a developmental disorder characterized by difficulties with social interaction and communication, and by restricted and repetitive behavior. 2.7 LEARNING ACTIVITY 1. Write a case study for “cognitive behaviour therapy” ……….................................……………………………………………………………………. ………………………………………………………………………………………………….. 2. Discuss Brain-based disorders are caused by neurochemical problems ……………………………….................................……………………………………………. ………………………………………………………………………………………………….. 2.8 UNIT END QUESTIONS A. Descriptive Questions Short Questions 59 CU IDOL SELF LEARNING MATERIAL (SLM)
1. What factors are complicating the study of child psychopathology 2. What is significance of child psychopathology 3. What are key concepts of Child Psychopathology 4. Explain common childhood mental disorders 5. What is anxiety and depression Long Questions 1. What is Oppositional Defiant Disorder 2. Explain Obsessive-Compulsive Disorder in Children 3. Explain Post-traumatic Stress Disorder in Children 4. What types of therapy are most effective for mental disorders in children? 5. Explain Behaviour Therapy B. Multiple Choice Questions 1. ________________ among children are described as serious changes in the way children typically learn, behave, or handle their emotions which cause distress and problems getting through the day. a. Stress b. Fears c. Disruptive behavior d. Mental disorder 2. Examples of behavior often seen in children with depression a. Not wanting to do or enjoy doing things. b. Having a hard time paying attention c. Showing changes in sleep patterns-eating a lot more or at less than usual d. All of these 3. Form of therapy that is used to change negative thoughts into more positive, effective ways of thinking, leading to more effective behavior. a. Behavior therapy b. Counselling therapy c. Cognitive therapy d. Talking therapy 4. When children act out persistently so that it causes serious problem at home, in 60 school, or with peers, they may be diagnosed with ______________. a. Oppositional Defiant Disorder b. Attention-deficit/hyperactivity disorder c. Conduct disorder CU IDOL SELF LEARNING MATERIAL (SLM)
5. This is the most common viral syndrome. Infection is confined to the meninges. This include fever, headache, neck stiffness, photophobia and vomiting. a. Acute flaccid paralysis b. Encephalitis c. Aseptic meningitis d. Encephalo-myelitis Answers 1-(d), 2-(d), 3-(c), 4-(a), 5-(c) 2.9 REFERENCES Textbook • Rowatt, W.C., LaBouff, J., Johnson, M., Froese, P., & Tsang, J. (2009). Associations among religiousness, social attitudes, and prejudice in a national random sample of American adults. Psychology of Religion and Spirituality. • Roy, K. (2014). Fathers on the frontiers of family change. Journal of Family Theory & Review. • Schermerhorn, A. C., Cummings, E. M., DeCarlo, C. A., & Davies, P. T. (2007). Children's influence in the marital relationship. Journal of Family Psychology. • Schleider, J. L., & Weisz, J. R. (2015). Using Mechanical Turk to study family processes and youth mental health: A test of feasibility. Journal of Child and Family Studies. Reference Books • Paolacci, G., Chandler, J., & Ipeirotis, P. G. (2010). Running experiments on amazon mechanical turk. Judgment and Decision Making. • Patterson, G. R. (1982). Coercive family process (Vol. 3). Eugene, OR: Castalia Publishing Company. • Phares, V. (2005). Are fathers involved in pediatric psychology research and treatment? Journal of Pediatric Psychology. • Phares, V., & Compas, B. E. (1992). The role of fathers in child and adolescent psychopathology: Make room for daddy. Psychological Bulletin. 61 CU IDOL SELF LEARNING MATERIAL (SLM)
UNIT 3: MENTAL RETARDATION PART I 62 STRUCTURE 3.0 Learning Objectives 3.1 Introduction 3.2 DSM Criteria 3.3 ICD 10 Criteria 3.3.1 Depressed Mood 3.3.2 Loss of Interest in Everyday Activities, 3.3.3 Reduction in Energy 3.4 Incidence 3.5 Prevalence 3.6 Causes of Mental Retardation 3.6.1 Down’s Syndrome 3.6.2 Fetal Alcohol Syndrome 3.6.3 Congenital Infections 3.6.4 Neurocutaneous Disorders 3.6.5 Lead Poisoning 3.6.6 Fragile X Syndrome 3.6.7 Brain Malformations 3.6.8 Inborn Errors of Metabolism 3.6.9 Protein-Energy Malnutrition 3.7 Summary 3.8 Keywords 3.9 Learning Activity 3.10 Unit End Questions 3.11 References 3.0 LEARNING OBJECTIVES After studying this unit, the student will be able to: • Explain the meaning of Retardation. • Explain the DSM criteria of retardation. • Explain the ICD 10 criteria of retardation. • Define depression, its symptoms, causes and treatment. CU IDOL SELF LEARNING MATERIAL (SLM)
3.1 INTRODUCTION The definition used most often in the United States is from the American Association on Mental Retardation (AAMR). According to AAMR, mental retardation is a disability that occurs before age 18. It is characterized by significant limitations in intellectual functioning and adaptive behaviour as expressed in conceptual, social, and practical adaptive skills. It is diagnosed through the use of standardized tests of intelligence and adaptive behaviour. AAMR points out that both functioning and adaptive behaviour are affected positively by individualized supports (AAMR, 2002). What assumptions are essential to applying this definition? • Limitations in present functioning must be considered within the context of community environments typical of the individual’s age, peers, and culture. • Valid assessment considers cultural and linguistic diversity as well as difference in communication, sensory, motor, and behavioural factors. • Within an individual, limitations often coexist with strengths. • An important purpose of describing limitations is to develop a profile of needed supports. • With appropriate personalized supports over a sustained period, the life functioning of the person with mental retardation generally will improve (AAMR, 2002). Intelligence Intelligence refers to a general mental capability. It involves the ability to reason, plan, solve problems, think abstractly, comprehend complex ideas, learn quickly, and learn from experience. Intelligence is represented by Intelligent Quotient (IQ) scores obtained from standardized tests given by trained professionals. Mental retardation is generally thought to be present if an individual has an IQ test score of approximately 70 or below (AAMR, 2002). Adaptive behaviour Adaptive behaviour is the collection of conceptual, social, and practical skills that have been learned by people in order to function in their everyday lives. Significant limitations in adaptive behaviour impact a person’s daily life and affect the ability to respond to a particular situation or to the environment. Limitations like the following can be determined by using standardized tests: Conceptual skills: receptive and expressive language, reading and writing, money concepts, and self-direction. Social skills: interpersonal, responsibility, self-esteem, is not gullible or naïve, follows rules, obeys laws, and avoids victimization. Practical skills: personal activities of daily living such as eating, dressing, mobility, and toileting; instrumental activities of daily living such as preparing meals taking medication, using the telephone, managing money, using transportation, and doing housekeeping activities; occupational skills; maintaining a safe environment. A significant deficit in one area impacts 63 CU IDOL SELF LEARNING MATERIAL (SLM)
individual functioning enough to constitute a general deficit in adaptive behaviour (AAMR, 2002). The effects of these disabilities vary considerably among people who have them, just as the range of abilities varies considerably among all people. Children may take longer to learn to speak, walk and take care of their personal needs, such as dressing or eating. People may take longer learning in school. As adults, many people will be able to lead independent lives in the community without paid supports. A small percentage will have serious, lifelong limitations in functioning. However, with early intervention, an appropriate education and supports as an adult, all can lead satisfying lives in the community. In American society, being labelled with “mental retardation” can be stigmatizing. People sometimes feel excluded or belittled. Supports include the resources and individual strategies necessary to promote the development, education, interests, and well-being of a person. Supports enhance individual functioning. Supports can come from family, friends, and community or from a service system. Job coaching is an example of a support provided by a service system. Supports can also be provided by a parent, sibling, friend, teacher, or any other person, such as a co-worker who provides a little extra support to someone on the job. Supports can be provided in many settings, and a “setting” or location by itself is not a support Developmental disabilities (DD) According to the Developmental Disabilities Act (Pub. L. 106-402), the term developmental disability means a severe, chronic disability that: 1. is attributable to a mental or physical impairment or a combination of those impairments. 2. occurs before the individual reaches age 22. 3. is likely to continue indefinitely. 4. results in substantial functional limitations in three or more of the following areas of major life activity: (i) self-care, (ii) receptive and expressive language, (iii) learning, (iv) mobility, (v) self-direction, (vi) capacity for independent living, and (vii) economic self-sufficiency; and 5. reflects the individual’s need for a combination and sequence of special, interdisciplinary, or generic services, individualized supports, or other forms of assistance that are of lifelong or extended duration and are individually planned and coordinated. Before the age of ten, an infant or child with developmental delays may be considered developmentally disabled if his or her disabilities are likely to meet the above criteria without intervention. Many states use different definitions for Developmental Disabilities based on earlier versions of the federal law. 64 CU IDOL SELF LEARNING MATERIAL (SLM)
The major differences are in the age of onset, the severity of limitations, and the fact that the developmental disability definition does not refer to an IQ requirement. Many individuals with mental retardation will also meet the definition of developmental disability. However, it is estimated that at least half of individuals with mental retardation will not meet the functional limitation requirement in the DD definition. The DD definition requires substantial functional limitations in three or more areas of major life activity. The mental retardation definition requires significant limitations in one area of adaptive behaviour. What does The Arc mean by related developmental disabilities? We are referring to individuals with cerebral palsy, epilepsy, developmental delay, autism, and autism spectrum disorders, fetal alcohol syndrome or any of hundreds of specific syndromes and neurological conditions that can result in impairment of general intellectual functioning or adaptive behaviour similar to that of a person with a cognitive or intellectual disability such as mental retardation. Studies have shown that somewhere between 1% and 3% of Americans have mental retardation, depending on how they are counted. Based on IQ score alone, the percentages would be closer to 3%. Prevalence studies may not identify all people with mental retardation. People including parents and professionals throughout the U.S. report that they are aware the label “mental retardation” can bring offense, and for this reason they avoid its use. Many school age children receive a diagnosis of learning disability, developmental delay, behaviour disorder, or autism instead of mental retardation. Many adults who technically could be said to have “mental retardation” live independent, productive lives and avoid all labels. Their success and their lack of functional limitations may mean that they are not included in studies that count the number of adults who have cognitive, intellectual, or related developmental disabilities. The Arc’s mission statement does not use the term “mental retardation.” Instead it says that we work to include children and adults with cognitive, intellectual, and developmental disabilities in every community. The term “mental retardation” was offensive to many people, so we changed our language. This does not change our commitment to the people we serve. The term “mental retardation” offers special protections in key areas of federal and state policy, including death penalty prosecutions and SSI administrative processes. The term should not be thought of as guaranteeing individual access to needed supports. Rather, access to supports under federal programs such as IDEA, SSI and Medicaid is usually based on a combination of functional assessments and state and local administrative plans. In most programs other than IDEA, financial eligibility is required. People still need to use the term “mental retardation” to be eligible for some services in a few states, but in no case does having the label guarantee that supports will be available. The Arc does not encourage states, officials, families, or individuals to use or promote the term “mental retardation.” The general 65 CU IDOL SELF LEARNING MATERIAL (SLM)
public, including families, individuals, funders, administrators, and public policymakers at local, state, and federal levels, are not necessarily aware that the term “mental retardation” is offensive and outdated. We find it necessary to use the term from time to time, as in this Q&A, to help people understand our issues. We try to use newer, more acceptable language as much as possible. We hope one day everyone will be known by their name, not by a label. 3.2 DSM CRITERIA DSM-5 defines intellectual disabilities as neurodevelopmental disorders that begin in childhood and are characterized by intellectual difficulties as well as difficulties in conceptual, social, and practical areas of living. The American Psychiatric Association's (APA) diagnostic criteria for intellectual disability (ID, formerly mental retardation) are found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5, APA 2013). A summary of the diagnostic criteria in DSM-5 are as follows: 1. Deficits in intellectual functioning This includes various mental abilities: • Reasoning. • Problem solving. • Planning. • Abstract thinking. • Judgment. • Academic learning (ability to learn in school via traditional teaching methods). • Experiential learning (the ability to learn through experience, trial and error, and observation). These mental abilities are measured by IQ tests. A score of approximately two standard deviations below average represents a significant cognitive deficit. These scores would occur about 2.5% of the population. Or stated differently, 97.5% of people of the same age and culture would score higher. The tests used to measure IQ must be standardized and culturally appropriate. This is typically an IQ score of 70 or below. Intellectual Functioning (Mental Abilities) An intellectual disability (ID, formerly mental retardation) is a specific type of disability. This disability is caused by significant limitations in intellectual functioning (mental abilities). These limitations make it difficult to acquire important life skills. This is called adaptive functioning. 66 CU IDOL SELF LEARNING MATERIAL (SLM)
Intellectual functioning is determined by many factors. However, a primary source of this capacity is mental ability or \"intelligence.\" Intelligence refers to the ability to reason, plan, think, and communicate. These abilities allow us to solve problems, to learn, and to use good judgment. One measure of intelligence is called the intelligence quotient, or IQ. There are standard tests that measure IQ. When someone's IQ score is below 70, it's likely they will have some problems. Because of how these tests are designed, 97.5% of the population would score above 70. These tests are discussed here. Although ID affects learning abilities, it is not the same as another type of disability called learning disability. Learning disabilities are limited to a specific type of learning. This type is called academic learning. These are the sorts of things taught in schools. Therefore, learning disabilities affect reading, writing, and math. In contrast, intellectual disabilities affect three different types of learning. These are academic learning, experiential learning, and social learning. Children with learning disabilities have trouble with one type: academic learning. Children with intellectual disabilities have trouble with all three: First, intellectual disabilities affect experiential learning. This type of learning occurs through cause and effect. For example, suppose a child touches a hot stove. This experience causes the child to learn to avoid touching a stove. A child with an ID does not learn from this painful experience. She does not understand the stove (the cause) caused the painful burn (the effect). Second, intellectual disabilities affect social learning. This learning occurs by observing other people in social situations. We learn social customs and rules by watching others. For instance, we might notice it is customary to greet people by shaking hands or offering a hug. Social learning enables us to learn social skills. These skills are needed to get along well with other people. Moreover, social skills are critical to life success. Third, intellectual disabilities affect academic learning. We learn useful skills and knowledge via formal education. These skills are reading, writing, and math. Thus, learning disabilities differ from ID because learning disabilities are limited to academic skills. In contrast, IDs include many types of learning problems. These learning difficulties make it hard to develop many practical life skills. In addition to learning problems, limited intellectual functioning affects social and emotional functioning. Many persons with ID function on an emotional and social level far below what is average for their age. Some people consider this emotional immaturity an endearing quality. The child-like innocence, trust, wonder, and sincerity can be quite charming. However, these very same qualities make people vulnerable to victimization and cruelty. Behavioural and Psychological Features of Intellectual Disabilities 67 CU IDOL SELF LEARNING MATERIAL (SLM)
Intellectual disabilities (ID, formerly mental retardation) have multiple causes. For example, there are many genetic causes. Brain injuries can cause an intellectual disability. Some types of medical conditions can also affect the brain's development. These causes are discussed in another section. These different causes mean each person's disability is unique. There is no single set of shared traits or features. For example, there are no personality traits common to people with ID. However, certain specific syndromes that cause ID have personality characteristics associated with that particular syndrome. For example, children with Williams's syndrome tend to be outgoing. However, by definition, all people with ID have limited intellectual functioning. These limitations often create some commonly observed difficulties. One such problem is impulse control. You may recall that people with ID have trouble connecting cause and effect. This in turn causes problems with impulse control. For instance, suppose a child sees yummy, hot cookies coming out of the oven. The child wants to grab one immediately. If not controlled, this impulse will cause a nasty burn. Experience is usually a great teacher. So, most children only make this impulsive mistake once or twice. They form a connection between the hot cookie (cause) and the burn (effect). They learn to control the impulse to grab a cookie right out of the oven. However, this is not so easily learned by people with ID. This poor impulse control leads to many unpleasant consequences. A related problem is poor frustration tolerance. When an impulse is inhibited, it requires the ability to tolerate a bit of frustration. This ability is called frustration tolerance. Frustration tolerance is an important developmental skill. It allows people to comfortably endure the small frustrations of everyday life. This in turn serves to limit the unpleasant consequences associated with impulsive behaviour. Returning to the previous example, it is frustrating to inhibit the impulse to grab a cookie. However, it avoids the consequence of a nasty burn. Frustration tolerance also enables people to build confidence. When we attempt to solve problems, our initial efforts may fail. This can be very frustrating. Without frustration tolerance, people give up. As a result, they do not put forth any effort. Clearly, if we make no effort to solve problems, we cannot develop the skills we need to solve them! Poor frustration tolerance is not the only problem. This is coupled with many more opportunities to become frustrated. Return to the prior example of a child's impulse to grab a hot cookie. If a caregiver attempted to stop the child from grabbing the cookie, it frustrates the child. She would not readily understand her caregiver's benevolent motivation. It bears mentioning that not all people with ID become easily frustrated. This example simply illustrates that the opportunities for frustration are significantly increased. The increased opportunities for frustration highlight the importance of frustration tolerance. People respond to frustration in different ways. Some people respond in an impulsive, stubborn, and aggressive manner. Others respond with passivity, withdrawal, and 68 CU IDOL SELF LEARNING MATERIAL (SLM)
compliance. Poor frustration tolerance may cause aggression toward caregivers. It may also lead to self-injurious behaviour. These behaviours are observed in some people with ID. Another common difficulty is low self-esteem. Self-esteem naturally develops as children learn to solve problems. The ability to solve problems builds self-confidence. However, limited intellectual functioning makes it difficult to solve problems. Skilful problem solving requires sustained attention and persistence in the face of difficulty. These abilities are limited in persons with limited intellectual functioning. Thus, a low self-esteem may develop. Psychiatric disorders related to low self-esteem, such as depression, may accompany intellectual disabilities. However, many people with ID are quite happy and content. They don't exhibit problematic behaviour. Genetic Causes of Intellectual Disabilities: Down syndrome Many intellectual disabilities (ID, formerly mental retardation) are caused by genetic abnormalities. The two most common genetic causes of intellectual disabilities are Down syndrome and Fragile X syndrome. 3.3 ICD 10 CRITERIA In 1978, WHO entered into a long-term collaborative project with the Alcohol, Drug Abuse and Mental Health Administration (ADAMHA) in the USA, aiming to facilitate further improvements in the classification and diagnosis of mental disorders, and alcohol- and drug- related problems (3). A series of workshops brought together scientists from a number of different psychiatric traditions and cultures, reviewed knowledge in specified areas, and developed recommendations for future research. A major international conference on classification and diagnosis was held in Copenhagen, Denmark, in 1982 to review the recommendations that emerged from these workshops and to outline a research agenda and guidelines for future work. Several major research efforts were undertaken to implement the recommendations of the Copenhagen conference. One of them, involving centres in 17 countries, had as its aim the development of the Composite International Diagnostic Interview, an instrument suitable for conducting epidemiological studies of mental disorders in general population groups in different countries (5). Another major project focused on developing an assessment instrument suitable for use by clinicians (Schedules for Clinical Assessment in Neuropsychiatry). Still another study was initiated to develop an instrument for the assessment of personality disorders in different countries (the International Personality Disorder Examination). In addition, several lexicons have been, or are being, prepared to provide clear definitions of terms. A mutually beneficial relationship evolved between these projects and the work on definitions of mental and behavioural disorders in the Tenth Revision of the International 69 CU IDOL SELF LEARNING MATERIAL (SLM)
Classification of Diseases and Related Health Problems (ICD-10) (9). Converting diagnostic criteria into diagnostic algorithms incorporated in the assessment instruments was useful in uncovering inconsistencies, ambiguities and overlap and allowing their removal. The work on refining the ICD-10 also helped to shape the assessment instruments. The final result was a clear set of criteria for ICD-10 and assessment instruments which can produce data necessary for the classification of disorders according to the criteria. The Copenhagen conference also recommended that the viewpoints of the different psychiatric traditions be presented in publications describing the origins of the classification in the ICD-10. This resulted in several major publications, including a volume that contains a series of presentations highlighting the origins of classification in contemporary psychiatry (10). The Clinical descriptions and diagnostic guidelines was the first of a series of publications developed from Chapter V (F) of ICD-10 (11). This publication was the culmination of the efforts of numerous people who have contributed to it over many years. The work has gone through several major drafts, each prepared after extensive consultation with panels of experts, national and international psychiatric societies, and individual consultants. The draft in use in 1987 was the basis of field trials conducted in some 40 countries, which constituted the largest ever research effort of its type designed to improve psychiatric diagnosis. The results of the trials were used in finalizing the clinical guidelines. The text presented here has also been extensively tested (14), involving researchers and clinicians in 32 countries. A list of these is given at the end of the book together with a list of people who helped in drafting texts or commented on them. Further texts will follow: they include a version for use by general health care workers, a multiaxial presentation of the classification, a series of 'fascicles' dealing in more detail with special problems (e.g. a fascicle on the assessment and classification of mental retardation) and \"crosswalks\" - allowing cross-reference between corresponding terms in ICD-10, ICD-9 and ICD-8. Use of this publication is described in the Notes for Users. The Appendix provides suggestions for diagnostic criteria which could be useful in research on several conditions which do not appear as such in the ICD-10 (except as index terms) and crosswalks allowing the translation of ICD-10 into ICD-9 and ICD-8 terms. The Acknowledgements section is of particular significance since it bears witness to the vast number of individual experts and institutions, all over the world, who actively participated in the production of the classification and the various texts that accompany it. All the major traditions and schools of psychiatry are represented, which gives this work its uniquely international character. The classification and the guidelines were produced and tested in many languages; the arduous process of ensuring equivalence of translations has resulted in improvements in the clarity, simplicity, and logical structure of the texts in English and in other languages. 70 CU IDOL SELF LEARNING MATERIAL (SLM)
The ICD-10 proposals are thus a product of collaboration, in the true sense of the word, between very many individuals and agencies in numerous countries. They were produced in the hope that they will serve as a strong support to the work of the many who are concerned with caring for the mentally ill and their families, worldwide. No classification is ever perfect: further improvements and simplifications should become possible with increases in our knowledge and as experience with the classification accumulates. The task of collecting and digesting comments and results of tests of the classification will remain largely on the shoulders of the centres that collaborated with WHO in the development of the classification. Their addresses are listed below because it is hoped that they will continue to be involved in the improvement of the WHO classifications and associated materials in the future and to assist the Organization in this work as generously as they have so far. Numerous publications have arisen from Field Trial Centres describing results of their studies in connection with ICD-10. A full list of these publications and reprints of the articles can be obtained from WHO, Division of Mental Health, Geneva. A classification is a way of seeing the world at a point in time. There is no doubt that scientific progress and experience with the use of these guidelines will require their revision and updating. I hope that such revisions will be the product of the same cordial and productive worldwide scientific collaboration as that which has produced the current text. Common ICD-10 Codes for Mental & Behavioural Health Mental, Behavioural and Neurodevelopmental disorders (F01-F99) Type 2 Excludes symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00- R99) Includes disorders of psychological development This block comprises a range of mental disorders grouped together on the basis of their having in common a demonstrable etiology in cerebral disease, brain injury, or other insult leading to cerebral dysfunction. The dysfunction may be primary, as in diseases, injuries, and insults that affect the brain directly and selectively; or secondary, as in systemic diseases and disorders that attack the brain only as one of the multiple organs or systems of the body that are involved. 71 CU IDOL SELF LEARNING MATERIAL (SLM)
3.3.1 Depressed Mood Depression is a state of low mood and aversion to activity. It can affect a person's thoughts, behaviour, motivation, feelings, and sense of well-being. The core symptom of depression is said to be anhedonia, which refers to loss of interest or a loss of feeling of pleasure in certain activities that usually bring joy to people. Depressed mood is a symptom of some mood disorders such as major depressive disorder or dysthymia; it is a normal temporary reaction to life events, such as the loss of a loved one; and it is also a symptom of some physical diseases and a side effect of some drugs and medical treatments. It may feature sadness, difficulty in thinking and concentration and a significant increase or decrease in appetite and time spent sleeping. People experiencing depression may have feelings of dejection, hopelessness and, sometimes, suicidal thoughts. It can either be short term or long term. Factors: Life events Adversity in childhood, such as bereavement, neglect, mental abuse, physical abuse, sexual abuse, or unequal parental treatment of siblings can contribute to depression in adulthood. Childhood physical or sexual abuse in particular significantly correlates with the likelihood of experiencing depression over the victim's lifetime. Life events and changes that may influence depressed moods include (but are not limited to): childbirth, menopause, financial difficulties, unemployment, stress (such as from work, education, family, living conditions etc.), a medical diagnosis (cancer, HIV, etc.), bullying, loss of a loved one, natural disasters, social isolation, rape, relationship troubles, jealousy, separation, or catastrophic injury. Adolescents may be especially prone to experiencing a depressed mood following social rejection, peer pressure, or bullying. Globally, more than 264 million people of all ages suffer from depression. The global pandemic of COVID-19 has negatively impacted upon individual’s mental health, causing levels of depression to surge, reaching devastating heights. A study conducted by the University of Surrey in Autumn 2019 and May/June 2020 looked into the impact of COVID-19 upon young people’s mental health. The study showed a significant rise in depression symptoms and a reduction in overall wellbeing during lockdown (May/June 2020) compared to the previous autumn (2019). Levels of clinical depression in those surveyed in the study were found to have more than doubled, rising from 14.9 per cent in autumn 2019 to 34.7 per cent in May/June 2020. This study further emphasizes the correlation that certain life events have with developing depression. Personality Changes in personality or in one's social environment can affect levels of depression. High scores on the personality domain neuroticism make the development of depressive symptoms 72 CU IDOL SELF LEARNING MATERIAL (SLM)
as well as all kinds of depression diagnoses more likely, and depression is associated with low extraversion. Other personality indicators could be temporary but rapid mood changes, short term hopelessness, and loss of interest in activities that used to be of a part of one's life, sleep disruption, withdrawal from previous social life, appetite changes, and difficulty concentrating. Alcoholism Alcohol can be a depressant which slows down some regions of the brain, like the prefrontal and temporal cortex, negatively affecting rationality and memory. It also lowers the level of serotonin in the brain, which could potentially lead to higher chances of depressive mood. The connection between the amount of alcohol intake, level of depressed mood, and how it affects the risks of experiencing consequences from alcoholism, were studied in a research done on college students. The study used 4 latent, distinct profiles of different alcohol intake and level of depression, Mild or Moderate Depression, and Heavy or Severe Drinkers. Other indicators consisting of social factors and individual behaviours were also taken into consideration in the research. Results showed that the level of depression as an emotion negatively affected the amount of risky behaviour and consequence from drinking, while having an inverse relationship with protective behavioural strategies, which are behavioural actions taken by oneself for protection from the relative harm of alcohol intake. Having an elevated level of depressed mood does therefore lead to greater consequences from drinking. Bullying Social abuse, such as bullying, are defined as actions of singling out and causing harm on vulnerable individuals. In order to capture a day-to-day observation of the relationship between the damaging effects of social abuse, the victim's mental health and depressive mood, a study was conducted on whether individuals would have a higher level of depressed mood when exposed to daily acts of negative behaviour. The result concluded that being exposed daily to abusive behaviours such as bullying has a positive relationship to depressed mood on the same day. The study has also gone beyond to compare the level of depressive mood between the victims and non-victims of the daily bullying. Although victims were predicted to have a higher level of depressive mood, the results have shown otherwise that exposure to negative acts has led to similar levels of depressive mood, regardless of the victim status. The results therefore have concluded that bystanders and non-victims feel as equally depressed as the victim when being exposed to acts such as social abuse. Medical treatments Depression may also be the result of healthcare, such as with medication induced depression. Therapies associated with depression include interferon therapy, beta- 73 CU IDOL SELF LEARNING MATERIAL (SLM)
blockers, isotretinoin, contraceptives, cardiac agents, anticonvulsants, antimigraine drugs, antipsychotics, and hormonal agents such as gonadotropin-releasing hormone agonist. Substance-induced Several drugs of abuse can cause or exacerbate depression, whether in intoxication, withdrawal, and from chronic use. These include alcohol, sedatives (including prescription benzodiazepines), opioids (including prescription pain killers and illicit drugs such as heroin), stimulants (such as cocaine and amphetamines), hallucinogens, and inhalants. Non-psychiatric illnesses Main article: Depression (differential diagnoses) Depressed mood can be the result of a number of infectious diseases, nutritional deficiencies, neurological conditions, and physiological problems, including hypoandrogenism (in men), Addison's disease, Cushing's syndrome, hypothyroidism, hyperparathyroidism, Lyme disease, multiple sclerosis, Parkinson's disease, chronic pain, stroke, diabetes, and cancer. Psychiatric syndromes Main article: Depressive mood disorders A number of psychiatric syndromes feature depressed mood as a main symptom. The mood disorders are a group of disorders considered to be primary disturbances of mood. These include major depressive disorder (MDD; commonly called major depression or clinical depression) where a person has at least two weeks of depressed mood or a loss of interest or pleasure in nearly all activities; and dysthymia, a state of chronic depressed mood, the symptoms of which do not meet the severity of a major depressive episode. Another mood disorder, bipolar disorder, features one or more episodes of abnormally elevated mood, cognition, and energy levels, but may also involve one or more episodes of depression. When the course of depressive episodes follows a seasonal pattern, the disorder (major depressive disorder, bipolar disorder, etc.) may be described as a seasonal affective disorder. Outside the mood disorders: borderline personality disorder often features an extremely intense depressive mood; adjustment disorder with depressed mood is a mood disturbance appearing as a psychological response to an identifiable event or stressor, in which the resulting emotional or behavioural symptoms are significant but do not meet the criteria for a major depressive episode; and posttraumatic stress disorder, a mental disorder that sometimes follows trauma, is commonly accompanied by depressed mood. 3.3.2 Loss of Interest in Everyday Activities People who experience anhedonia have lost interest in activities they used to enjoy and have a decreased ability to feel pleasure. It’s a core symptom of major depressive disorder, but it 74 CU IDOL SELF LEARNING MATERIAL (SLM)
can also be a symptom of other mental health disorders. Some people who experience anhedonia don’t have a mental disorder. What are the symptoms of anhedonia? The two main types of anhedonia are social and physical anhedonia. • Social anhedonia is a disinterest in social contact and a lack of pleasure in social situations. • Physical anhedonia is an inability to feel tactile pleasures such as eating, touching, or sex. • The symptoms of anhedonia include: • social withdrawal • a lack of relationships or withdrawal from previous relationships • negative feelings toward yourself and others • reduced emotional abilities, including having less verbal or nonverbal expressions • difficulty adjusting to social situations • a tendency toward showing fake emotions, such as pretending you’re happy at a wedding • a loss of libido or a lack of interest in physical intimacy • persistent physical problems, such as being sick often What are the causes of anhedonia? Anhedonia is a core symptom of depression, but not everyone who’s depressed experiences anhedonia. Prescription medication, especially medications like antidepressants and antipsychotics used to treat depression, can cause anhedonia. Schizophyte is a psychology theory that certain personality traits may be a risk factor for developing psychotic disorders, such as schizophrenia. Social anhedonia is a risk factor for schizophrenia. Anhedonia may also occur due to recreational drug use or having a large amount of stress or anxiety. What are the risk factors for anhedonia? • If you have a family history of major depression or schizophrenia, you have an 75 increased risk of anhedonia. Other risk factors include: • a recent traumatic or stressful event • a history of abuse or neglect • an illness that impacts your quality of life • a major illness • an eating disorder CU IDOL SELF LEARNING MATERIAL (SLM)
• Females are also at an increased risk of anhedonia. How is anhedonia diagnosed? Your doctor will ask you questions about your symptoms and your general mood. Make a list of all of your symptoms before your appointment, including the loss of experiencing pleasure. Telling your doctor all of your symptoms will help them to see the full picture and make a diagnosis. Your doctor may perform a physical exam to determine if you have any physical problems. Additionally, your doctor may draw blood to test for a vitamin deficiency or thyroid problem, which may be contributing to your mood disorder. 3.3.3 Reduction in energy Mental exhaustion can happen to anyone who experiences long-term stress. It can make you feel overwhelmed and emotionally drained, and make your responsibilities and problems seem impossible to overcome. Feelings of detachment and apathy can wreak havoc on all aspects of your personal and work life. You may feel trapped in your situation and as if the power to do anything about it is out of your hands, but you can overcome mental exhaustion with some help. Mental exhaustion symptoms Mental exhaustion causes physical as well as emotional symptoms. It can also impact your behaviour, which others may notice even before you do. Symptoms of mental exhaustion can vary from person to person and often begin to show gradually, creeping up on you during periods of extreme stress. If stress continues to weigh on you, you may reach a point when you feel as though you’re in a dark hole and can’t see your way out. Many people refer to this as “burnout,” though it’s not officially a recognized medical term. Even if you’re not experiencing all of the signs and symptoms, it’s important to recognize these are signs that could indicate you are on the path to mental exhaustion or burnout. Emotional signs • Emotional signs of mental exhaustion may include: 76 • depression • anxiety • cynicism or pessimism CU IDOL SELF LEARNING MATERIAL (SLM)
• apathy (feeling of not caring) • detachment • anger • feelings of hopelessness • feeling of dread • lack of motivation • decline in productivity • difficulty concentrating • Physical signs • Physical signs of mental exhaustion may include: • headaches • upset stomach • body aches • chronic fatigue • changes in appetite • insomnia • weight gain or weight loss • increased illness, such as colds and flu • Behavioural signs • Your mental exhaustion can cause you to behave in ways that are out of character for you. Behavioural signs may include: • poor performance at work • social withdrawal or isolation • inability to keep personal or work commitments • calling in sick to work or school more often • Stress vs. mental exhaustion Stress is something everyone experiences from time to time. It’s our body’s natural response to positive and negative situations that are new, exciting, or scary. This biological response results in a surge of stress hormones, including adrenaline and cortisol. This boost of hormones helps us react quickly to perceived threats and high-pressure situations that require quick thinking. Once the stressor has been removed, your body should go back to normal. Mental exhaustion is usually the result of long-term stress. When you’re continually dealing with things that activate your body’s stress response, your cortisol levels remain high. Eventually, this begins to interfere with normal body functions, such as digestion, sleep, and your immune system. 77 CU IDOL SELF LEARNING MATERIAL (SLM)
Physical exhaustion vs. mental exhaustion Physical exhaustion, which is an extreme state of unrelenting fatigue that leaves you physically drained, is a side effect that can be brought on by mental exhaustion. A 2017 review of 11 studies noted that mental exhaustion impairs physical performance and can make even simple tasks or exercise feel considerably more physically taxing and demanding. Mental exhaustion causes The terms mental exhaustion and burnout are often used to refer to being overworked or related to stress in the workplace, but mental exhaustion can be caused by a long period of persistent stress in any area of your life. While the triggers of mental exhaustion aren’t the same for everyone, some are more common than others. Common causes of mental exhaustion include: • high-pressure occupations, such as emergency responders and teachers • working long hours • financial stress and poverty • job dissatisfaction • being a caregiver for an ill or aging loved one • living with a chronic illness • death of a loved one • having a baby • poor work-life balance • lack of social support • Treating and coping with mental exhaustion There are lifestyle changes and techniques you can use at home to help you cope with stress and alleviate the symptoms of mental exhaustion. Remove the stressor It’s not always possible to eliminate the source of your stress, but it is the best way to treat stress. If you’re overwhelmed by your responsibilities at home or work, consider asking for help with tasks or delegating some of your responsibilities to others. 78 CU IDOL SELF LEARNING MATERIAL (SLM)
Enlisting the help of professional services is another way to help lighten your load, such as respite care or a personal support worker if you’re a caregiver for a loved one. Babysitting, cleaning, and running errands are other responsibilities you can outsource. Take a break Time to rest and recharge is an important part of treating mental exhaustion. This can mean taking an extended vacation, clearing your schedule for a couple of days, or even just taking a bit of time for yourself each day. Taking a walk on your lunch break or taking in a movie with a friend once a week can do wonders for your stress levels. Exercise It’s not easy to find the motivation to exercise even on a good day, but exercise has many proven benefits for your physical and emotional health. You don’t need to engage in a complex or high-intensity activity to reap the benefits. Moderate exercise, such as a brisk walk, is enough. A 2010 cross-sectional study of 533 Swiss police and emergency response service corps found that exercise was associated with enhanced health and protected against stress-related health problems. The participants of the study also felt better prepared to cope with chronic stress. Based on results, moderate exercise was better suited to reduce stress than vigorous exercise. Other proven benefits of exercise include: • lowered stress levels • reduced anxiety • improved mood • a stronger immune system 3.4 INCIDENCE The World Health Organization describes mental health as a state of wellbeing in which every person realizes its own potential and can face the normal stress of life, work productively and is capable of contributing to his/her community. Health is both physical and mental wellbeing rather than mere absence of a disease (1). Mental retardation includes below-average intellectual functioning with significant limitation of adaptive functioning, which occurs before the age of 18 (2). According to the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-X) (3), mental retardation is defined as a condition of delayed or incomplete development of the 79 CU IDOL SELF LEARNING MATERIAL (SLM)
mind characterized by impairment of skills contributing to overall development of intelligence, i.e. reasoning, speech, motor control and social contacts demonstrated during the development. Mental retardation is divided to four sub-categories (3): mild mental retardation (IQ 50 - 70), moderate mental retardation (IQ 35 - 49), severe mental retardation (IQ 20 – 34), and profound mental retardation (IQ is below 20 (3). In the next revision, ICD-11, it is expected that the term mental retardation will be replaced either by the term intellectual disability or intellectual developmental disorder, which are already used by the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.)(DSM-5) (2,4). Intellectual disability affects around 1-3% of the general population (5,6). Global developmental delay (GDD) occurs in psychomotor development of 3% of children under the age of 5 and is defined as developmental disorder with a delay in two or more developmental areas: gross or fine motor skills, speech, cognition (cognitive processes), social functioning and everyday activities (7). Around 75-90% of persons with intellectual difficulties have mild intellectual disability. Approximately one quarter of cases is caused by a genetic disorder (8). Due to high incidence of physical and mental comorbidity with intellectual disability, such persons require more attention than mere health care services and have a higher need for resources in health care than persons from the general population (9). Persons with intellectual disability need equal access to health care without any discrimination based on their disability. Without adequate health care, medical problems of persons with intellectual disability often remain unrecognized (10). Even when they are identified, such problems are often insufficiently or inadequately addressed (11,12). Such differences among persons with intellectual disability in general population significantly increase the risk for treatment of the disease and may lead to early death (13). Stigma may be a key factor for failure to ask for assistance and has a negative impact on seeking assistance. Facing and prevention of stigma and discrimination should be integral parts of a support process to all persons with mental disorders, particularly children and young people (14). Persons with intellectual disability often have poor access to medical services and their treatment involves very high costs for the health care system and the entire society (15-17). Despite those facts persons with intellectual disability are mostly neglected in the field of mental health, where specialized services are limited. Such specialized services can be provided mainly in countries with high income, primarily western countries. The war in Bosnia and Herzegovina caused serious suffering of the population and led to devastation of psychosocial institutions, therefore, a small number of psychosocial institutions has remained operational, the Public Institute for Placement of Persons with Mental Disability “Drin” Fojnica being among them. It also accommodates patients with psychiatric disorders and provides them with psychological, social, and medical support in addition to persons with mental retardation, who were its original beneficiaries. The aim of this retrospective study was to investigate frequency of mental retardation in comparison with 80 CU IDOL SELF LEARNING MATERIAL (SLM)
other psychiatric disorders at the Public Institute for Placement of Persons with Mental Disabilities „Drin“ Fojnica, Bosnia and Herzegovina (B&H), in the period 2013-2014 to asses psychosocial condition and necessary support for persons diagnosed with mental retardation depending on a degree of mental retardation. The research will provide guidelines for the protection and promotion of mental health of persons placed in psychosocial institutions. 3.5 PREVALENCE The Prevalence of Mental Retardation Research on prevalence clearly illustrates many of the problems concerning our current conception of mental retardation. The difficulties in identifying mentally retarded persons make it nearly impossible to arrive at totally accurate figures. Moreover, professionals in the field don't always agree on the definition of retardation — a factor that makes it difficult to arrive at universally acceptable figures on prevalence. There is little disagreement on the criteria for defining moderate, severe, and profound mental retardation. However, authorities are not always in agreement on how to define the largest proportion of the mentally retarded population — those generally termed as mildly retarded. Society itself seems to have difficulty with this distinction. For example: Some children have enough problems with school subjects to be labelled as mentally retarded by the school system itself. However, when these children go home at the end of the day — or leave school permanently — they function relatively well in society. Thus, while school personnel and classroom peers may consider such children as mentally retarded, family, friends and neighbours outside the school setting may consider them merely \"slow.\" Surveys of organizations, agencies and clinics identify only those persons who have come into contact with those organizations. Varying testing methods utilized by different schools and agencies tend to cloud the issue of what is mental retardation. Current cut-off points for mental retardation range from IQ 70 to IQ 80. A low IQ, of course, is not the only criterion for mental retardation. A mentally retarded person must also exhibit impaired adaptive behaviour. Only those studies which measure both intelligence and adaptive behaviour meet the demands of the current definition of mental retardation. Current prevalence figures range from 2.36 percent to 3.52 percent. One summary of the best prevalence studies available indicates that 2.5 to 3 percent of the general population is mentally retarded — based on the 1980 census, this totals from 5.5 to 6.7 million people. According to one report, the vast majority of the retarded population, an estimated 87 percent, is mildly retarded. Roughly 10 percent is moderately retarded, and only 3 percent is severely or profoundly retarded. 81 CU IDOL SELF LEARNING MATERIAL (SLM)
While mental retardation strikes all segments of society, it is far more likely to occur in some groups than in others. Prevalence studies indicate that there are more mentally retarded males than females — perhaps a 60-40 ratio. Male susceptibility to traumatic experiences such as premature birth, brain damage, and various dangers after birth, account for some differences in the ratio of mental retardation. However, there is some evidence that parental and teacher attitudes toward male \"behavioural problems\" have a definite bearing on prevalence figures. Both parents and teachers prefer quiet children to disruptive children. Thus, the boy who expresses his anger or aggression is more likely to be sent to the school psychologist or the principal. Apparently, there is a difference between the prevalence of mental retardation in males and females — but the difference may not be as marked as some authorities have reported. Is mental retardation more prevalent in one age group than in another? While some studies indicate a preponderance of retardation in some age groupings, other researchers feel that differences in prevalence at different ages are the result of inaccurate reporting procedures. As mentioned, individuals who appear mentally retarded in some settings do not appear retarded in others. One study showed that individuals labelled as mentally retarded in school went on to lead independent, productive lives in the community. There is an obvious relationship between poverty and mental retardation. Malnutrition, lead poisoning and a lack of proper medical care are only a few of the factors that may contribute to the disproportionate incidence of mental retardation among the disadvantaged members of our society. Lead poisoning is almost exclusively associated with conditions of poverty. Inadequate medical care contributes to a higher rate of infant mortality, and a higher rate of birth defects. There is a marked difference between current prevalence studies and studies completed during the early 1900s. At least two factors account for these differences: improved methods of research and changing definitions of mental retardation. Many mildly retarded individuals who would have blended into society some years ago are now being counted before they take their places in the community. In the future, it may be that the term \"mentally retarded\" will be reserved only for the most severely disabled individuals. An ongoing characteristic of mental retardation is the fact that, in one respect, the more we learn about this disability, the harder it is to define. An ever- increasing number of mildly retarded persons are taking their places in society. Probably the majority of the people in this country who have been labelled as mentally retarded fall into that grey area of \"relative retardation.\" Except for the most extreme cases, mentally retarded persons refuse to fit neatly into one category or another. Methods of testing intelligence frequently fail to show how a particular individual has adjusted to his environment and made a place for himself. 82 CU IDOL SELF LEARNING MATERIAL (SLM)
The presence of this large, Gray area of mental retardation makes it next to impossible to accurately determine the number of mentally retarded individuals living in society. Still, the fact that there is a problem in determining the prevalence of mental retardation is a healthy sign for those concerned with the welfare of mentally retarded citizens: We are becoming less aware of the differences in people, and more aware of the similarities. 3.6 CAUSES OF MENTAL RETARDATION There are various known causes of mental retardation, including genetic disorders, maternal infections, psychosocial conditions, drug exposure, and environmental chemical exposure. The established risk factors for MR include: [3] Various genetic disorders (e.g. Down’s Syndrome, phenylketonuria) Certain maternal infections during pregnancy (e.g. rubella) Mother who abuses substances such as alcohol during pregnancy Certain psychosocial conditions (e.g. problems with caregiving, low socioeconomic status, low parental education) Maternal exposure to various drugs (e.g. thalidomide, valproic acid) Maternal exposure to environmental chemicals (discussed in detail later) The expanding scientific knowledge base has led to a rejection of the simplistic debate over \"organic\" versus \"environmental\" causes of retardation. There is a growing recognition of the interactive contributions of nature and nurture to the development of all children. PCBs: PCBs, or polychlorinated biphenyls, are members of a chemical family that were widely used in the past in industry as lubricants, coatings, and insulation materials for electrical equipment like transformers and capacitors. Several human studies have linked exposure to higher levels of PCBs with decreased intellectual function. However, these intellectual deficits were generally modest. 3.6.1 Down’s Syndrome Down syndrome (sometimes called Down’s syndrome) is a condition in which a child is born with an extra copy of their 21st chromosome — hence its other name, trisomy 21. This causes physical and mental developmental delays and disabilities. Many of the disabilities are lifelong, and they can also shorten life expectancy. However, people with Down syndrome can live healthy and fulfilling lives. Recent medical advances, as well as cultural and institutional support for people with Down syndrome and their families, provides many opportunities to help overcome the challenges of this condition. 83 CU IDOL SELF LEARNING MATERIAL (SLM)
In all cases of reproduction, both parents pass their genes on to their children. These genes are carried in chromosomes. When the baby’s cells develop, each cell is supposed to receive 23 pairs of chromosomes, for 46 chromosomes total. Half of the chromosomes are from the mother, and half are from the father. In children with Down syndrome, one of the chromosomes doesn’t separate properly. The baby ends up with three copies, or an extra partial copy, of chromosome 21, instead of two. This extra chromosome causes problems as the brain and physical features develop. According to the National Down Syndrome Society (NDSS), about 1 in 700 babies in the United States is born with Down syndrome. It’s the most common genetic disorder in the United States. Trisomy 21 Trisomy 21 means there’s an extra copy of chromosome 21 in every cell. This is the most common form of Down syndrome. Mosaicism Mosaicism occurs when a child is born with an extra chromosome in some but not all of their cells. People with mosaic Down syndrome tend to have fewer symptoms than those with trisomy 21. Translocation In this type of Down syndrome, children have only an extra part of chromosome 21. There are 46 total chromosomes. However, one of them has an extra piece of chromosome 21 attached. Certain parents have a greater chance of giving birth to a child with Down syndrome. According to the Centers for Disease and Prevention, mothers aged 35 and older are more likely Trusted Source to have a baby with Down syndrome than younger mothers. The probability increases the older the mother is. Research shows that paternal age also has an effect. One 2003 study found that fathers over 40 had twice the chance of having a child with Down syndrome. Other parents who are more likely to have a child with Down syndrome include: • people with a family history of Down syndrome • people who carry the genetic translocation 84 CU IDOL SELF LEARNING MATERIAL (SLM)
It’s important to remember that no one of these factors mean that you’ll definitely have a baby with Down syndrome. However, statistically and over a large population, they may increase the chance that you may. Though the likelihood of carrying a baby with Down syndrome can be estimated by screening during pregnancy, you won’t experience any symptoms of carrying a child with Down syndrome. At birth, babies with Down syndrome usually have certain characteristic signs, including: • flat facial features • small head and ears • short neck • bulging tongue • eyes that slant upward • atypically shaped ears • poor muscle tone An infant with Down syndrome can be born an average size, but will develop more slowly than a child without the condition. People with Down syndrome usually have some degree of developmental disability, but it’s often mild to moderate. Mental and social development delays may mean that the child could have: • impulsive behavior • poor judgment • short attention span • slow learning capabilities Medical complications often accompany Down syndrome. These may include: • congenital heart defects 85 • hearing loss • poor vision • cataracts (clouded eyes) • hip problems, such as dislocations • leukaemia • chronic constipation • sleep apnea (interrupted breathing during sleep) • dementia (thought and memory problems) • hypothyroidism (low thyroid function) • obesity • late tooth growth, causing problems with chewing CU IDOL SELF LEARNING MATERIAL (SLM)
• Alzheimer’s disease later in life People with Down syndrome are also more prone to infection. They may struggle with respiratory infections, urinary tract infections, and skin infections. Living with Down syndrome The lifespan for people with Down syndrome has improved dramatically in recent decades. In 1960Trusted Source, a baby born with Down syndrome often didn’t see their 10th birthday. Today, life expectancy for people with Down syndrome has reached an average of 50 to 60 years. If you’re raising a child with Down syndrome, you’ll need a close relationship with medical professionals who understand the condition’s unique challenges. In addition to larger concerns — like heart defects and leukaemia — people with Down syndrome may need to be guarded from common infections such as colds. People with Down syndrome are living longer and richer lives now more than ever. Though they can often face a unique set of challenges, they can also overcome those obstacles and thrive. Building a strong support network of experienced professionals and understanding family and friends is crucial for the success of people with Down syndrome and their families. 3.6.2 Fetal Alcohol Syndrome FAS occurs when a foetus becomes exposed to alcohol. This exposure typically occurs Trusted Source when a pregnant person drinks alcohol, and it enters the foetus’s bloodstream through the umbilical cord. As a foetus’s liver is not fully formed, this organ cannot metabolize alcohol. As a result, when a foetus becomes exposed to alcohol, they absorb all of it. Alcohol is a teratogen, which means that it is toxic to developing babies. Teratogens can interfere with a foetus’s growth and development, particularly that of the central nervous system (CNS), which includes the brain and spinal cord. Signs and symptoms FAS can cause a range of physical, mental, and behavioural complications. These range from mild to severe and may include Trusted Source: • Physical signs • low body weight • below-average height • poor coordination • small head size 86 CU IDOL SELF LEARNING MATERIAL (SLM)
• small eyes • abnormal facial features, such as smooth skin between the nose and upper lip • thin upper lip • bone deformities, especially in the fingers and limbs • heart, kidney, or bone problems • vision or hearing problems • Behavioural signs • hyperactive behaviour • sleep problems • difficulty suckling as a baby • trouble regulating emotions or behaviour • resistance to change • inability to empathize or recognize indirect social cues • Learning and cognitive difficulties • difficulty remembering • trouble paying attention • finding school challenging, especially subjects such as math • intellectual disabilities or low IQ • speech and language delays • poor judgment and reasoning skills • trouble planning or being organized • difficulty understanding cause and effect A child with FAS will not necessarily have all of these symptoms. Additionally, many of these symptoms can occur due to other conditions. A healthcare professional specializing in FAS can help determine the cause. 3.6.3 Congenital Infections A congenital (present at birth) infection is caused by a virus. The infection is passed to the baby through the placenta during pregnancy, or may be in the birth canal during delivery. When an unborn foetus or infant (birth to 1 year*) catches the virus, the effects of the virus are much more severe. These children may suffer from cognitive disorders, hearing loss, autism spectrum disorder or other complications. In extreme cases, a congenital infection may be life-threatening. Cytomegalovirus (CMV) Paediatric cytomegalovirus (CMV) is a very common herpes virus, but can cause serious problems for new-borns. Group B streptococcus 87 CU IDOL SELF LEARNING MATERIAL (SLM)
Streptococcus is a type of bacteria that can lead to a wide variety of other conditions, including strep throat or rheumatic fever. Hepatitis B Hepatitis B is the most serious of the paediatric forms of hepatitis. It can be passed via blood or bodily fluids, like saliva, sweat or semen. Hepatitis B can cause advanced liver damage throughout a child’s life. Herpes simplex The herpes simplex virus (HSV) can cause a blister(s) anywhere on the skin. It most commonly occurs around the mouth, or on the lips, nose, genitals, and buttocks. Human immune deficiency virus (HIV) HIV is a virus that attacks the CD4 cells (T cells), which are responsible for several immune responses in your body, such as fighting off bacteria, viruses, or parasites. This causes your immune system to become weakened, which can lead to infections or infection-related cancers. HIV can also lead to AIDS (acquired immunodeficiency syndrome), but a person is not guaranteed to develop AIDS if they have HIV. 3.6.4 Neurocutaneous Disorder Neurocutaneous syndromes are disorders that affect the brain, spinal cord, organs, skin, and bones. The diseases are lifelong conditions that can cause tumours to grow in these areas. They can also cause other problems such as hearing loss, seizures, and developmental problems. Each disorder has different symptoms. The most common disorders in children cause skin growths. The 3 most common types of neurocutaneous syndromes are: Tuberous sclerosis (TS) Neurofibromatosis (NF), including NF1, NF2, and Schwannomatosis Sturge-Weber disease 3.6.5 Lead Poisoning Lead poisoning occurs when lead builds up in the body, often over months or years. Even small amounts of lead can cause serious health problems. Children younger than 6 years are especially vulnerable to lead poisoning, which can severely affect mental and physical development. At very high levels, lead poisoning can be fatal. Lead-based paint and lead-contaminated dust in older buildings are the most common sources of lead poisoning in children. Other sources include contaminated air, water, and soil. Adults 88 CU IDOL SELF LEARNING MATERIAL (SLM)
who work with batteries, do home renovations or work in auto repair shops also might be exposed to lead. There is treatment for lead poisoning, but taking some simple precautions can help protect you and your family from lead exposure before harm is done. 3.6.6 Fragile X Syndrome Fragile X syndrome affects a child's learning, behaviour, appearance, and health. Symptoms can be mild or more severe. Boys often have a more serious form of it than girls. Children who are born with this genetic condition can get special education and therapy to help them learn and develop like other kids. Medicines and other treatments can improve their behaviour and physical symptoms. Symptoms of Fragile X There are several, including: • Trouble learning skills like sitting, crawling, or walking • Problems with language and speech • Hand-flapping and not making eye contact • Temper tantrums • Poor impulse control • Anxiety • Extreme sensitivity to light or sound • Hyperactivity and trouble paying attention • Aggressive and self-destructive behaviour in boys • Some children with fragile X also have changes to their face and body that can include: • A large head • A long, narrow face • Large ears • A large forehead and chin • Loose joints • Flat feet • Enlarged testicles (after puberty) 3.6.7 Brain Malformations Congenital abnormalities, called malformations, are conditions affecting the form and function of the nervous system. 89 CU IDOL SELF LEARNING MATERIAL (SLM)
There are numerous variations of congenital malformations of the bone and soft tissue of the head and spine, including neural tube defects, such as spina bifida, encephaloceles, Chiari malformations and arachnoid cysts. Some congenital malformations are mild, and some are severe but correctable with surgery by a paediatric neurosurgeon. Types of Congenital Brain and Spine Malformations Chiari Malformations This is a condition in which portions of the brain — the cerebellar tonsils — protrude through the bottom opening of the skull into the upper spine, which can put pressure on the brain or spinal cord. Chiari malformations may block the flow of cerebrospinal fluid, leading to hydrocephalus. Treatments often focus on removing portions of the bone and soft tissue to relieve pressure on the spinal cord and brain, as well as providing new pathways to drain cerebrospinal fluid. Surgeons have several different methods for treating these malformations, including decompression, with or without duraplasty (opening the dura, the thick membrane covering the brain). 3.6.8 Inborn Errors Metabolism Inborn errors of metabolism are rare genetic disorders that affect the body’s metabolism. Metabolism [meh-TAB-uh-lih-zem] describes the body’s ability to convert food and drink into energy, as well as get rid of certain wastes made during that process. It’s a complex process that uses many different chemicals, enzymes, hormones, cells, and organs to work properly. Enzymes are special proteins that cause chemical reactions. When we eat, the digestive system uses enzymes to break down the food into sugars, amino acids, fatty acids, and other chemicals that can be used by the body. The body uses these chemicals as fuel or energy, as well as to build or repair tissues. Anything that can’t be used by the body is waste. Enzymes can also help convert or break down wastes so they can be removed from the body. With inborn errors of metabolism, certain enzymes don’t work properly or the body doesn’t make enough of an enzyme. This disrupts the process of metabolism. The body may be blocked from using substances it needs to function. Or, waste substances can build up in the body and become toxic. These issues can cause health problems, including serious developmental problems in young children. Inborn errors of metabolism are genetic, meaning they are inherited and are often present at birth. New-borns are screened for several serious conditions, including metabolic, hormone, 90 CU IDOL SELF LEARNING MATERIAL (SLM)
and blood disorders. Early detection and treatment of certain disorders can prevent lifelong health problems. Symptoms There are several different inborn errors of metabolism. Symptoms will depend on the specific condition. Metabolic disorders often cause a variety of signs and symptoms. Common symptoms include: • Unintended weight loss, or a failure to gain weight and grow in babies and children • Tiredness and lack of energy • Hypoglycaemia or low blood sugar • Poor feeding habits • Stomach problems or vomiting • High levels of acid or ammonia in the blood • Abnormal liver function • Developmental delays in babies and children • Seizures or other central nervous system problems Your new-born was likely screened for some metabolic disorders at birth. However, see a doctor if you notice and signs or symptoms of a metabolic disorder. Early treatment of inborn errors of metabolism is key to preventing long-term health problems. 3.6.9 Protein-Energy Malnutrition Protein-energy malnutrition (PEM) is the inappropriate loss of body cell mass secondary to reduced intake or inadequate utilization of substrate. Children, especially neonates, are particularly prone to develop PEM since they have minimal metabolic reserve to combat illness. Either reduced intake or inadequate absorption may lead to caloric deprivation, which is variously labelled as starvation, wasting, or marasmus. Conversely, a hypermetabolic inflammatory process may trigger inadequate utilization of protein substrate while nonprotein caloric intake remains relatively unaffected, which is called hypermetabolism or kwashiorkor. The prevalence of PEM in hospitalized children in the United States approaches that in the underdeveloped countries, ranging from 36% to 54%.152 The distinction between starvation and hypermetabolism is important and will affect the choice of nutritional therapy, to prevent the detrimental complications of under- or overfeeding.110 Since PEM contributes greatly to morbidity in heart disease, it is important to understand this entity. Protein-energy Malnutrition in Children Protein-energy malnutrition (PEM) is a common childhood disorder and is primarily caused by deficiency of energy, protein, and micronutrients. PEM manifests as underweight (low body weight compared with healthy peers), stunting (poor linear growth), wasting (acute weight loss), or edematous malnutrition (kwashiorkor). Case fatality rates among children 91 CU IDOL SELF LEARNING MATERIAL (SLM)
hospitalized with severe wasting or edema (also known as severe acute malnutrition [SAM]) range from 5% to 30%. All forms of PEM are associated with increased risk of infectious illnesses and cognitive deficit. Children with SAM and associated acute illnesses should be treated in a hospital setting using World Health Organization (WHO) guidelines. Management of most forms of PEM can be done in the community setting by improving household food security, promoting appropriate complementary food, providing micronutrients, providing anti-helminthic treatment, and preventing (e.g., by vaccines) and treating infectious illnesses. As the liver is central in the metabolism, assimilation, and synthesis of protein, it is not surprising that protein-energy malnutrition (PEM) is common in patients with chronic liver disease. PEM refers to the increased catabolism of muscle and other visceral proteins for gluconeogenesis. PEM in chronic liver disease has been well documented with a prevalence of 27–100%. The severity of PEM is dependent on etiology and length of disease, with alcoholic liver disease patients being worst affected. 3.7 SUMMARY • Mental retardation is a disability that is characterized by significant limitations that are both intellectual functioning and in adaptive behavior that are expressed in conceptual, social and practical skills. • This will mean that such a problem will be from the age of about 18 years of age. This problem can occur to people from all races; ethnic, educational and social background meaning this problem is not made to a certain ethnic group but can occur to all in a country. • The goal setting is very important to these people because they will be given assistance and support that is important to lead their life just like normal people. This means that in setting a goal on how to deal with these mentally disabled people a nation should be well equipped with professionals who will be ready to work out the problems with a lot of concern so that they can deal with the problem perfectly. • In setting a goal then there is need to have income even if it will mean to borrow of get assistance from other countries. This is with the idea that this goal that is set so that people can be saved requires a lot of income as they have to hire professionals who are fully qualified, meaning that it is an expensive task for a country that has limited income. • Individual support plan will be the assistance that a person will require so that he or she can live and work in a country without problems. • This is linked to family support where a goal has to be achieved in ensuring that people live together and have happy lives. This individual plan will have the natural capacity that is important for one to meet the needs that are important and required in his or her life. (Mary, 1995) 92 CU IDOL SELF LEARNING MATERIAL (SLM)
• There is offering of additional support such as resources, goods and services and financial assistance this will be aimed at ensuring that this person has a life that ids not with problems but very happy to do what is necessary in life. • There is need for this plan to have enhancement of community to value and support people who have disabilities and their families this will be through provision of services that are important so that they can deal with dangers of lack of main things that are required in that body of an individual. • This plan will have other requirements like ensuring that these people are catered for by the country in giving then services that are important so that they can have better lives than others. • This will be through offering treatments at early stages in lives of people so that they can know this problem and deal with it before it gets into worst stages. • This is important in that people who are mentally disabled can be treated if the problem has been diagnosis at the right time and right attention taken meaning that if a child is seen to have this problem then it will mean that this person will require care and attention so that they can live and have assistance in live. 3.8 KEYWORDS • Intelligence quotient (IQ) is a total score derived from a set of standardized tests or subtests designed to assess human intelligence • Adaptive behavior refers to the age-appropriate behaviours that people with and without learning disabilities need to live independently and to function well in daily life • Mental retardation (MR) refers to substantial limitations in present functioning. It starts before age 18 and is characterized by significantly subaverage intellectual functioning, existing concurrently with related limitations in two or more of the following applicable adaptive skill areas: communication • Fetal alcohol syndrome is a condition in a child that results from alcohol exposure during the mother's pregnancy. • Abstract thinking is the ability to understand concepts that are real, such as freedom or vulnerability, but which are not directly tied to concrete physical objects and experiences. 3.9 LEARNING ACTIVITY 1. Study different sources of Lead Poisoning in Children. ….................................................................................................................................................. ………………………………………………………………………………………………….. 93 CU IDOL SELF LEARNING MATERIAL (SLM)
2. Discuss effects of Fragile X syndrome on child's learning. ….................................................................................................................................................. ………………………………………………………………………………………………….. 3.10 UNIT END QUESTIONS A. Descriptive Questions Short Questions 1. what is “Intelligence” 2. Explain “Adaptive behaviour” 3. How do cognitive and intellectual disabilities such as mental retardation affect individuals? 4. What is the definition of developmental disabilities (DD)? 5. How does the DD definition compare with the AAMR definition of mental retardation? Long Questions 1. How many people are affected by mental retardation? 2. Explain if it necessary to continue to use the term “mental retardation?” 3. What is Intellectual Functioning (Mental Abilities) 4. Discuss behavioural and psychological features of Intellectual Disabilities 5. What are ICD-10 Codes for Mental & Behavioural Health B. Multiple Choice Questions 1. __________ refers to general mental capability. It involves the ability to reason, plan, solve problems, think abstractly, comprehend complex ideas, learn quickly and learn from experience. a. Adaptive Behavior b. Intelligence c. Behavior d. Reasoning 2. In what year WHO entered into a long-term collaborative project with the Alcohol, Drug Abuse and Mental Health Administration (ADAMHA) in USA aiming to facilitate further improvement in the classification and diagnosis of mental disorders. a. 1998 b. 1948 c. 1978 94 CU IDOL SELF LEARNING MATERIAL (SLM)
d. 1968 3. What is this product of collaborative work between numerous individuals and agencies from different countries who are concern with caring for mentally ill and their families worldwide? a. WHO b. DSM 5 c. BC 45 d. ICD 10 4. This is known to slow down some regions of the brain, like the prefrontal and temporal cortex, negatively affecting rationality and memory. a. Social abuse b. Depression c. Alcohol d. Lie events 5. A psychology theory that says certain personality traits may be a risk factor for developing psychotic disorder, such as schizophrenia. a. Cognitive Theory b. Schizotypy c. Humanistic d. Structuralism Answers 1-(b), 2-(c), 3-(d), 4-(c), 5-(b) 3.11 REFERENCES Textbooks: • Krishnakumar, A., & Buehler, C. (2000). Interparental conflict and parenting behaviors: A meta‐analytic review. Family Relations. • Lamb, M. E. (Ed.). (2010). The role of the father in child development (5th ed). Hoboken, N.J.: Wiley. • Lovejoy, M. C., Weis, R., O'Hare, E., & Rubin, E. C. (1999). Development and initial validation of the Parent Behavior Inventory. Psychological Assessment. • Lundahl, B. W., Tollefson, D., Risser, H., & Lovejoy, M. C. (2007). A meta-analysis of father involvement in parent training. Research on Social Work Practice References: 95 CU IDOL SELF LEARNING MATERIAL (SLM)
• Feinberg, M. E., Brown, L. D., & Kan, M. L. (2012). A multi-domain self-report measure of coparenting. Parenting. • Flouri, E. (2010). Fathers’ behaviors and children’s psychopathology. Clinical Psychology Review. • Frick, P. J. (1991). The Alabama parenting questionnaire. Unpublished rating scale, University of Alabama. • Horton, J. J., & Chilton, L. B. (2010, June). The labour economics of paid crowdsourcing. In Proceedings of the 11th ACM conference on Electronic commerce ACM. 96 CU IDOL SELF LEARNING MATERIAL (SLM)
UNIT 4: MENTAL RETARDATION PART II STRUCTURE 4.0 Learning Objectives 4.1 Introduction 4.2 Assessment with Cognitive Tests 4.3 Psychological Tests 4.4 Specific Syndrome Tests 4.5 Prognosis and Treatment 4.6 Summary 4.7 Keywords 4.8 Learning Activity 4.9 Unit End Questions 4.10 References 4.0 LEARNING OBJECTIVES After studying this unit, students will be able to: • Iidentify and evaluate mental retardation. • Explain assess wit cognitive test. • Explain assess using psychological testing. 4.1. INTRODUCTION The term “intellectual disability” is gradually replacing the term “mental retardation” nationwide. Advocates for individuals with intellectual disability have rightfully asserted that the term “mental retardation” has negative connotations, has become offensive to many people, and often results in misunderstandings about the nature of the disorder and those who have it. Mental retardation or intellectual disability comprises five general categories: borderline, mild, moderate, severe, and profound. Categories are based on scores obtained through use of age-standardized tests of cognitive ability. 97 CU IDOL SELF LEARNING MATERIAL (SLM)
If your child has an intellectual disability (ID), their brain hasn’t developed properly or has been injured in some way. Their brain may also not function within the normal range of both intellectual and adaptive functioning. In the past, medical professionals called this condition “mental retardation.” There are four levels of ID: • mild • moderate • severe • profound Sometimes, ID may be classified as: • “other” • “unspecified” ID involves both a low IQ and problems adjusting to everyday life. There may also be learning, speech, social, and physical disabilities. Severe cases of ID may be diagnosed soon after birth. However, you might not realize your child has a milder form of ID until they fail to meet common developmental goals. Almost all cases of ID are diagnosed by the time a child reaches 18 years of age. Symptoms of intellectual disability Symptoms of ID will vary based on your child’s level of disability and may include: • failure to meet intellectual milestones • sitting, crawling, or walking later than other children • problems learning to talk or trouble speaking clearly • memory problems • inability to understand the consequences of actions • inability to think logically • childish behaviour inconsistent with the child’s age • lack of curiosity • learning difficulties • IQ below 70 • inability to lead a fully independent life due to challenges communicating, taking care of themselves, or interacting with others If your child has ID, they may experience some of the following behavioural issues: • aggression 98 • dependency • withdrawal from social activities CU IDOL SELF LEARNING MATERIAL (SLM)
• attention-seeking behaviour • depression during adolescent and teen years • lack of impulse control • passivity • tendency toward self-injury • stubbornness • low self-esteem • low tolerance for frustration • psychotic disorders • difficulty paying attention Some people with ID may also have specific physical characteristics. These can include having a short stature or facial abnormalities. Levels of intellectual disability ID is divided into four levels, based on your child’s IQ and degree of social adjustment. Mild intellectual disability Some of the symptoms of mild intellectual disability include: • taking longer to learn to talk, but communicating well once they know how • being fully independent in self-care when they get older • having problems with reading and writing • social immaturity • increased difficulty with the responsibilities of marriage or parenting • benefiting from specialized education plans • having an IQ range of 50 to 69 Moderate intellectual disability If your child has moderate ID, they may exhibit some of the following symptoms: • are slow in understanding and using language • may have some difficulties with communication • can learn basic reading, writing, and counting skills • are generally unable to live alone • can often get around on their own to familiar places • can take part in various types of social activities • generally having an IQ range of 35 to 49 Severe intellectual disability Symptoms of severe ID include: 99 CU IDOL SELF LEARNING MATERIAL (SLM)
• noticeable motor impairment • severe damage to, or abnormal development of, their central nervous system • generally having an IQ range of 20 to 34 Profound intellectual disability Symptoms of profound ID include: • inability to understand or comply with requests or instructions • possible immobility • incontinence • very basic nonverbal communication • inability to care for their own needs independently • the need of constant help and supervision • having an IQ of less than 20 Other intellectual disability People in this category are often physically impaired, have hearing loss, are nonverbal, or have a physical disability. These factors may prevent your child’s doctor from conducting screening tests. Unspecified intellectual disability If your child has an unspecified ID, they will show symptoms of ID, but their doctor doesn’t have enough information to determine their level of disability. 4.2 ASSESSMENT WITH COGNITIVE TEST Cognitive testing, also called neurocognitive testing or psychometric testing, assesses your ability to think clearly and to determine if any mental conditions exist. If so, this testing allows one to determine if said condition is getting better or worse. Assessments of this kind can be used in mental health facilities or for employment screenings. Early versions of cognitive tests were established around 100 years ago and developed through the ages. “Pencil and pen” tests were widely used up until the advent of computerized testing in the 1970s and 1980s. These new tests offered more accurate data reporting and a better assessment on response time. Cognition tests are not necessarily considered intelligence tests, or IQ tests. As reported by Cog State, an Australian cognitive science and technology company, these assessments measure three common areas of cognition: memory, executive function, and attention. Of course, these areas have more specific facets. The questions asked during a cognitive test aim to explore basic function and these areas. Some cognitive regions that may be tested are: 100 CU IDOL SELF LEARNING MATERIAL (SLM)
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