Mental+Retardation+and+Autism+Spectrum+Disorders

=**Mental Retardation and Autism Spectrum Disorders**=


 * 1. Define developmental disabilities according to the public law 100-146, IDEA legistlation, and identify areas of functional limitation.**

__Developmental disabilitiey:__ any severe and chronic mental or physical disability of a person that is manifest before the individual reaches the age of 22 years in three or more of the following areas:
 * self-care
 * receptive and expressive language
 * learning
 * mobility
 * self-direction
 * independent living
 * economic self-sufficiency

According to the law all children with disabilities provided free appropriate education in least restrictive environment until 21.


 * 2. Define mental retardation, its prevalence, and list the levels of mental retardation.**

Significant sub-average intellectual functioning on an individually administered IQ test (IQ < 70). Concurrent deficits or impairments in present adaptive functioning in two or more areas: self-care, home living, social/interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health & safety. Onset before age 18 years. Occurs in 1-3% of population, more likely in boys 1.5/1, higher % reported in non-white populations in US. Code level of MR on Axis II:
 * Mild (IQ = 50-55 to about 70)
 * Moderate (IQ = 35-40 to 50-55)
 * Severe (IQ = 20-25 to 35-40)
 * Profound (IQ below 20-25)
 * Unspecified


 * 3. Review the comorbidity of mental retardation with other disorders.**

Mental retardation often occurs with other conditions: Epilepsy, Cerebral Palsy, Autism, Pervasive Developmental Disorder, Fetal Alcohol Syndrome, Down Syndrome.


 * 4. Discuss the major prenatal factors (genetic and non-genetic) and postnatal causes of mental retardation.**

Over 50 genetic diseases associated with MR, accounting for 7-15% of MR cases. 30-40% of MR due to known causes with chromosomal abnormalities acct. for up to 30% of Severe MR, 4-8% of Mild MR. Fragile X- 30-50% of full mutation carrier females have Mild to Moderate MR. Prader-Willi Syndrome - 50-70% of PWS have small paternal deletion of chromosome 15, majority of others have two copies of maternal chromosome 15. Inborn errors of metabolism such as Phenylketonuria (PKU) can lead to retardation without special diet. Increased risk of MR with maternal smoking 1.6 fold for any smoking to 1.9 for 1 pack a day. Fetal Alcohol Syndrome-related to heavy and prolonged alcohol use, maternal consumption of 2 > drinks a day associated with 7pt. IQ decrease Environmental contaminants such as PCB’s. Infections such as Human Cytomegalovirus, Congenital syphilis, Herpes Simplex Virus (HSV). Perinatal Asphyxia and Low Birth Weight also contribute to MR.

Postnatal causes account for small % (3-15%) of all MR with 1/3 related to infections. Postnatal causes include Environmental contaminants such as Lead and Mercury. Injury & Other Causes – account for majority of MR due to postnatal causes such as Head trauma due to child battering, MVA, Falls.


 * 5. Define autism and the criteria for diagnosis of autism.**

Delays or abnormal functioning in at least one of the following areas prior to age 3 years: social interaction, language as used in social communication, or symbolic or imaginative play. Six or more items from the following three criterion: Social Interaction, Social Communication, and Restricted, repetitive, stereotyped behavior/interests/activities, with at least two from Social Interaction and one from each of Social Communication and Restricted, repetitive, stereotyped behavior/interests/activities.

__Social Interaction:__
 * marked impairment in the use of multiple nonverbal behaviors (e.g., eye to eye gaze, facial expression, body posture, gestures regulating social interactions
 * failure to develop appropriate peer relationships
 * lack of spontaneous seeking to share enjoyment, interests, achievements with other people
 * lack of social or emotional reciprocity

__Social Communication:__
 * delay in or total lack of spoken language (not including alternative modes of communication)
 * if adequate speech, marked impairment in ability to initiate or sustain conversation
 * stereotyped and repetitive use of language or idiosyncratic language
 * lack of varied, spontaneous make believe play

__Restricted, repetitive, stereotyped behavior/interests/activities:__
 * encompassing preoccupation with one or more stereotyped/restricted patterns of interest - abnormal in intensity or focus
 * inflexible adherence to specific nonfunctional routines or rituals
 * stereotyped and repetitive motor mannerisms (hand & finger flapping, twisting, whole body movements)
 * preoccupation with parts of objects

Not better accounted by Rett’s or CDD


 * 6. Distinguish between autistic disorder, Asperger's disorder, Rett's disorder, and childhood disintegrative disorder.**

Autistic disorder includes criterion that encompass Social interaction, Social behavior and interests/activites.

Asperger’s focuses primarily on impairment of social interaction, with no clinically significant general delay in language, cognitive development, or adaptive impairment in age appropriate self-help skills.

Rett’s Disorder has apparent normal prenatal and perinatal development with onset of all of following after period of normal development: deceleration of head growth between ages 5 - 48 months, loss of previously acquired purposeful hand skills between 5 - 30 mos. with development of stereotyped hand movements (hand washing, hand wringing), loss of social engagement early in the course (but may develop later), apparent poorly coordinated gait or trunk movements, severely impaired expressive and receptive language development with severe psychomotor retardation. Seen mostly in boys

Childhood disintegrative disorder Childhood Disintegrative Disorder has normal development for 2 years followed by clinically significant loss of previously acquired skills before age 10 in at least two or more areas: expressive or receptive language, social skills or adaptive behavior, bowel or bladder control, play, motor skills, qualitative, impairment in social interaction, qualitative impairment in communication, restricted, repetitive & stereotyped patterns of behavior.


 * 7. Identify the appropriateness of using the diagnosis of pervasive developmental disorder NOS.**

Used when there are severe and pervasive impairment in the development of reciprocal social interaction or verbal and nonverbal communication that does not meet a specific PDD, Schizophrenia, personality disorder (Schizotypal). Often referred to as “atypical autism”


 * 8. Summarize treatment options and potential outcomes for autism spectrum disorders.**


 * Pharmacotherapy: Atypical Antipsychotics, SSRI’S, Stimulants
 * Psychosocial Interventions: Behavior modification including Applied Behavior Analysis (ABA), Contingency Management, Shaping, differential reinforcement of other behaviors (DRO), Parent training.
 * Educational Interventions: Specialized school services, Developmentally Handicapped (DH), Otherwise Health Impaired (OHI), Autistically Impaired (AI)
 * Early Identification & Intervention: is very important to have a positive influence. Infants as young as 4 months show signs that may be recognized by those trained. Early identification and treatment leads to better outcomes.