Table14.

2 - Mental Retardation Facts at a Glance

Prevalence

Approximately 1% ofthe general population has mental retardation; however, prevalence

estimates vary depending on the survey method used and the particular population studied.

Onset

Severe and profound retardation are generallyidentified at birth, although in some cases,
mental retardation is caused by a medical condition later in childhood, such as head trauma.
Mild retardation is sometimes not diagnosed until relatively late in childhood, although the
onset may have been earlier.

Comorbidity
Compared to the general population, people with mental retardation are three to four times
more likely to have an additional psychological disorder.
Among the most common comorbid disorders are major depressive disorder and attention
deficit/hyperactivity disorder.
Symptoms of mental retardation may affect the presentation of symptoms of a comorbid
disorder; people with severe or profound mental retardation, for instance, may not be able to
report feelings of hopelessness or depressed mood.

Course

The diagnosis is typically lifelong for moderate to profound mental retardation, but beneficial
environmental factors can improve adaptive functioning for those with mild mental retardation to
the point where they no longer meet all the criteria for the disorder.
Educational opportunities, support, and stimulation can improve the level offunctioning.

Gender Differences

.Mental retardation occurs more frequently in males, with a male-to-female ratio of 1.5 to 1.

Cultural Differences

Although the criteria for mental retardation used in other countries are similar to those used in
the United States, they are not always the same; such differences may account for the higher
prevalence rates in some other countries, such as 4.5% in France (0akland et al, 2003).
Source: Unless otherwise noted, the source for information is American Psychiatric Association, 200o.
Key Concepts and FactsAbout Mental Retardation
The diagnosis of mental retardation requires both an 1Q score
at or below 70 and impaired daily functioning. The four levels
of mental retardation are mild, moderate, severe, and profound.
Some
or
people with mentalretardation-particularlyat the severe
level- may have difficulty communicating verbally.
profound
Neurological factors are the primary direct cause of most cases
retardation-usually a genetic abnormality or prena
of mental
Making
tal exposure to a teratogen such
as alconol. in turn, tne gEe
abnormality or teratogen alters brain structure and function.
Although mental retardation cannot be cured, many types can
be prevented, includ ing PKU-related retardation (through early
detection and dietary modification) and retardation caused by
lead poisoning (by removing lead from the environment). In-
terventions are designed to improve the person's functioning
by increasing his or her communication and daily living skills.
Children whose symptoms make verbal communication difficult
may be taught alternative methods of communication, such as
the Picture Exchange Communication System (PECS).
Legally, children with mental retardation are entitled to special
education and related services, tailored to their individual needs
through an individu alized education program (EP).
a Diagnosis
Reread Case 14.1 about Larry, and determine whether or
not
his symptoms meet the criteria for mental retardation.
Specifi
cally,list which criteria apply and which do not. If you would
like more infor mation to determine his diagnosis, what in
formation-speciically-would you want, and in what ways
would the information influence your decision? If you think he
did have mental what level of retardation do you
retardati on,
think he has and why-on what do you base your decision?
 Table 14.5 Autistic Dis order Facts at a Glance

Prevalence

Significantly less than 1% of the population has this disorder; prevalence estimates range
from o.o2% to o.2%.
The reported prevalence of autism is increasing (Atladóttir, 2007; Hertz-Picciotto & Delwiche,
2009), at least in part because of earlier diagnosis of the disorder (Parner, Schendel, &
Thorsen, 2008).

Onset

Symptoms usually arise during infancy and include an indifference or aversion to physical
contact, no eye contact or smiles, a lack of response to parents' voices, a lack of emotional
attachment to parents, and the unusual use of toys (Ozonoff et al., 2008).
According to the DSM-V.TR criteria, symptoms must arise by age 3.
Autism may be diagnosed as early as 14 months of age (Landa, Holman, & Garrett-Mayer, 2007).

Comorbidity
Mental retardation is a common comorbid disorder-between 5o% and 70% of those with
autism also have mental retardation (Sigman, Spence, & Wang, 2006). However, some
researchers believe the high comorbidity is an overestimate (Edelson, 2006), particularly be-
cause individuals with autism tend to have higher 1Qs when tested using nonverbal 1Q tests.
Some researchers make a distinction between autism that co-occurs with mental retardation,
which leads to a relatively low level of functioning, and autism without mental retardation, which
is not generally associated with as low a level of functioning (Koyama et al., 2007).

Course

Children with autism often improve in some areas of functioning during the elementary
school years (Shattuck et al., 2007).
During adolescence, some children's symptoms worsen, whereas other children's symptoms
improve (American Psychiatric Association, 20o0; Shattuck et al., 2007).

Gender Differences

Males are four to five times more likely than females to develop autism.
Source: Unless otherwise noted, the source for information is American Psychiatric Association, 200o.
KeyConcepts and Facts About Pervasive Developmental Disorders
Pervasive developmental disorders involve two types of prob
lems: (1) significant deficits in communication and social inter
action skills, and (2) stereotyped behaviors or narrow interests.
Disorders in this category are autistic disorder, Asperger's disor
der, childhood disintegrative disorder, and Rett's disorder.
Autistic disorder (orsimply, autism)
is characterized by
cant problems with communication, social interactions, and lan-
signif
guage use. Individuals with autism are oblivious to other people
and do not pay attention to or understand basic social rules and
cues. They may have extremely narrow interests involving repet
Interventions for autism include medication for comorbid disor-
ders or symptoms of anxiety, agitati on, and aggression. Medi-
cation is not usually prescribed for symptoms of Asperger's
disorder. Treatment for autism that targets psychological factors
includes applied behavior analysis to modify maladaptive be
haviors. Treatments that target psychological and social factors
focus on teaching the individual to communicate, to recognize
conventional social cues, and to read the emotional expres
sions of others, as well as how to initiate and respond in social
situations.

itive play. Many people with autism also have comorbid mentalIn contrastdisoto autism and Asperger's disorder, childhood disin-
retardation
that
when tested with conventional intelligence tests;
verbal abilities, however, people with
is
tegrative rder characterized by normal development up to
on

tests doto score

autism
not
relyinonthe at least 2 years of age, followed by a profound loss of communi-
tend average range
some people with autism have unique skills.
or higher.
In addition,
cation skills, normal types of play, and bowel control.

Rett's disorder also involves the loss of skills already mastered,

Asperger's disorder is characterized by problems that are simi- but the onset of the disorder occurs between 5 months and
severe than-those
lar to-though less
With Asperger's, however,
associated
with autism.
2abilityof age. The child loses interest in other people and the
yearsto control normal muscle movements. Mental retardation
language and cognitive development
are in the normal range. People with Asperger's avoid eye con- always accompanies Rett's disorder, which affects only females.
tact and are often unaware of other people's responses. They
may be interested in social relationships but because they
do Making a Diagnosis
notgenerally understand conventional social rules, forming and Reread Case 14.2 about James, and determine
maintaining relationships is difficult whe ther or not
his symptoms meet the criteria for autism. Specifically, list
Neurological factors that underlie autismdifferent abnormal con-
includebrain which criteria apply and which do not. If you would like more

nections and communication among areas, in

lobe and the rest of the brain.
information to determine his diagnosis, what information-
particular, between the frontal of autism and
Genes play role in the specifically-would you want, and in what ways would the in for
a
development Asperger's. mation influence your decision?
Psychological symptoms of autism include deficits in shifting at Reread Case 14.3 about Josh, and determine whether or not his
tention and in mental flexibility, and an impaired theory of mind. symptoms meet the criteria for Asperger's disorder. Specifically,
People with Asperger's have less severe problems in using a list which criteria apply and which do not. If you would like more
theory of mind than do people with autism. Social symptoms of information to determine his diagnosis, what information-
autism include problems in recognizing emotion in the voices or
specifically-would you want, and in what ways would the infor
faces of others and in understanding the give and take of social mation influence your decision?
communication.
 Table 14.15 Attention-Deficit/Hyperactivity Disorder Facts at a Glance
Prevalence
The estimated prevalence of ADHD in school-aged children increased from 6% in 1997 to 9% in
2006 (National Center for Health Statistics, 2oo8).
Prevalence among American adults is about 4%(Kessler et al., 2006).
Comorbidity
Common comorbid disorders include mood and anxiety disorders and learning disorders
Children with hyperactive and impulsive symptoms are more likely to be diagnosed with op-
positional defiant disorder or conduct disorder than are those with inattentive symptoms
(Christophersen & Mortweet, 2001): In surveys of the general population, 5o-75% of children
with ADHD also meet the criteria for conduct disorder (Kazdin, 1995). Another study found
that over half of children with ADHD had comorbid oppositional defiant disorder (Biederman
et al., 1996).
Onset
Children are not usually diagnosed before age 4 or 5 because the range of normal behavior for
preschoolers is very wide.
In younger children, the diagnosis is generally based more on hyperactive and impulsive symp-
toms than on inattention symptoms.
DSM-IV-TR requires that the disorder have its onset by age 7; however, research suggests that
onset may occur up to age 12. Note, however, that diagnosis may occur much later.
Course
Symptoms of ADHD become obvious during the elementary school years, when attentional
problems interfere with schoolwork.
By early adolescence, the more noticeable signs of hyperactivity-difficulty sitting stil, for
example-typically diminish to a sense of restlessness or a tendency to fidget.
Children who had ADHD but not oppositional defiant disorder or conductdisorder in childhood
have a higher risk of developing adolescent-onset conduct disorder than do peers who had
none of those disorders in childhood (Mannuzza et al., 2004).
As adults, people with ADHD may avoid sedentary jobs because oftheir restlessness.
Gender Differences
Males are more likely-in one survey, more than twice as likely-to be diagnosed with ADHD,
particularly the hyperactive/impulsive type, although this gender difference may reflect a
bias in referrals to mental health clinicians rather than any actual difference in prevalence
(Biederman et al., 2005; National Center for Health Statistics, 2008).
Cultural Differences
I n the United States, non-Hispanic white children are more likely to be diagnosed with ADHD
than are Hispanic or black children (Havey et al., 2005; Stevens, Harman, & Kelleher, 2005).
Worldwide, the prevalence of the disorder among children averages about 5% (Polanczyk &
Rohde, 2007), although some studies find higher prevalence rates (Bird, 2002; Ofovwe,
Ofovwe, & Meyer, 20o6); the variability across countries can be explained by the different
thresholds at which behaviors are judged as reaching a symptomatic level, as well as some
what different diagnostic criteria (Bird, 2002).

Source: Unless otherwise noted, the source for information is American Psychiatric Association, 20oo.
Table14.9 Learning Disorders
Facts at a Glance

Prevalence

Between 2% and 10% of Americans are

estimated to have a learning disorder.
Five percent of public school students in
the United States are diagnosed with a
learning disorder.

Onset

Symptoms of learning disorders do not

usually emerge until early in elementary
school typically kindergarten through
3rd grade), when the relevant academic
skills are needed.
Children with a high IQ and a reading or
mathematics disorder may not be diag-
nosed until the 4th grade or later.
Symptoms appear rapidly when they
arise froma serious medical problem.

Comorbidity
Common comorbid disorders include
depressive disorders and attention
deficit/hyperactivity disorder.
Mathematics disorder and written
expression disorder commonly co-occur
with reading disorder.

Course

With early identification and interven

tion, a significant number of children
with reading disorder can overcome their
difficulties.

Gender Differences

Between 60% and 80% of people with

reading disorder are male; however,
males may be more likely to be diagnosed
because of their disruptive behavior,
which calls attention to their difficulties.

Cultural Differences

I n the United States, Hispanic children

are least likely to be diagnosed with
a learning disorder, perhaps because
language barriers make it more difficult
to diagnose (National Center for Health
Statistics, 2008).
Source: Unless otherwise noted, the source for
information is American Psychiatric Associatio n, 2000.