Assignment

Assignment ## 01
01

ALLAMA IQBAL OPEN UNIVERSITY, ISLAMABAD

(Department of Special Education)

Course Title: Introduction and Assessment of Mentally

Retarded Children-I
Course Code: 3603
Semester: Spring, 2021
Programme: M.A (SPL. EDU)
Credit Hours: 3
Total Marks: 100
Pass Marks: 40

Respected Mr:
Dr. WAHEED AKBAR

Student Information:
Student Name: JAHAN ARA
Roll #: CC525729
Question No. 1:
Write a comprehensive note on etiology, characteristics and available medical treatments
for children with microcephaly.

Answer:
Microcephaly:
Microcephaly is an uncommon neurological disorder in which an infant's head is noticeably
smaller than other infants of the same age and gender. Microcephaly is a condition in which
the brain develops improperly in the womb or does not grow as it should after birth. It is often
discovered at birth.
A variety of genetic and environmental factors can cause microcephaly. Developmental
problems are common in children with microcephaly. Microcephaly doesn't usually have a
treatment, but early intervention with supportive treatments like speech and occupational
therapy can aid your child's development and quality of life.

How Many Babies are Born with Microcephaly?

Microcephaly is not a common condition. Researchers estimate that about 1 in every 800-5,000
babies is born with microcephaly in the United States.

Etiology of Microcephaly:
Microcephaly is caused by faulty brain growth that can happen in the womb (congenital) or
throughout childhood. Microcephaly could be inherited.
1. Genetic conditions
Genetic conditions that can cause microcephaly include:
A. Cornelia de Lange syndrome
Cornelia de Lange syndrome slows your child’s growth inside and outside of the womb.
Common characteristics of this syndrome include:
 Intellectual problems
 Arm and hand abnormalities
 Distinct facial features
For example, children with this condition often have:
 Eyebrows that grow together in the middle
 Low-set ears
 A small nose and teeth
B. Down syndrome
Down syndrome is also known as trisomy 21. Children with trisomy 21 typically have:
 Cognitive delays
 Mild to moderate intellectual disability
 Weak muscles
 Distinctive facial features, such as almond-shaped eyes, a round face, and
small features
C. Cri-du-chat syndrome
Babies with cri-du-chat syndrome, or cat’s cry syndrome, have a distinct, high-pitched cry, like
that of a cat. Common characteristics of this rare syndrome include:
 Intellectual disability
 Low birth weight
 Weak muscles
 Certain facial features, such as wide-set eyes, a small jaw, and low-set ears
D. Rubinstein-Taybi syndrome
Babies with Rubenstein-Taybi syndrome are shorter than normal. They also have:
 Large thumbs and toes
 Distinctive facial features
 Intellectual disabilities
People with the severe form of this condition often don’t survive past childhood.
E. Seckel syndrome
Seckel syndrome is a rare condition that causes growth delays in and out of the womb. Common
characteristics include:
 Intellectual disability
 Certain facial features, including a narrow face, beak-like nose, and sloping jaw.
 F. Smith-Lemli-Opitz syndrome
Babies with Smith-Lemli-Opitz syndrome have:
 Intellectual disabilities
 Behavioral disabilities that mirror autism

Early signs of this disorder include:

 Feeding difficulties
 Slow growth
 Combined second and third toes
G. Trisomy 18
Trisomy 18 is also known as Edward’s syndrome. It can cause:
 Slow growth in the womb
 Low birth weight
 Organ defects
 An irregularly shaped head
Babies with Trisomy 18 usually don’t survive past the 1st month of life.

2. Exposure to viruses, drugs, or toxins

Microcephaly can also occur when your child is exposed to certain viruses, drugs, or toxins in
the womb. For example, using alcohol or drugs while pregnant can cause microcephaly in
children. The following are other potential causes of microcephaly:

A. Zika virus
Infected mosquitos transmit Zika virus to humans. The infection usually isn’t very serious.
However, if you develop the Zika virus disease while you’re pregnant, you can transmit it to
your baby. NZika virus may cause microcephaly and several other serious birth defects. These
include:
 Vision and hearing defects
 Impaired growth
 B. Methylmercury poisoning
Some people use methylmercury to preserve the seed grain that they feed animals. It can also
form in water, leading to contaminated fish. Poisoning occurs when you eat contaminated
seafood or meat from an animal that’s been fed seed grain that contains methylmercury. If your
baby is exposed to this poison, they may develop brain and spinal cord damage.
C. Congenital rubella
If you contract the virus that causes German measles, or rubella, within the first 3 months of
pregnancy, your baby may develop severe problems. These problems can include:
 Hearing loss
 Intellectual disability
 Seizures
However, this condition isn’t very common due to the use of the rubella vaccine.
D. Congenital toxoplasmosis
If you’re infected with the parasite Toxoplasma gondii while you’re pregnant, it can harm your
developing baby. Your baby may be born prematurely with many physical problems, including:
 Seizures
 Hearing and vision loss
This parasite is found in some cat feces and uncooked meat.
E. Congenital cytomegalovirus
If you contract the cytomegalovirus while you’re pregnant, you can transmit it to your fetus
through your placenta. Other young children are common carriers of this virus. In infants, it
can cause:
 Jaundice
 Rashes
 Seizures
If you’re pregnant, you should take precautions, including:
 Washing your hands frequently
 Not sharing utensils with children under 6 years old

F. Uncontrolled phenylketonuria (PKU) in the mother

If you’re pregnant and have phenylketonuria (PKU), it’s important to follow a low-
phenylalanine diet. This substance is found in milk, eggs and aspartame sweeteners. If you
consume too much of phenylalanine, it can harm your developing baby
 3. Delivery complications

Microcephaly may also be caused by certain complications during delivery.

 Decreased oxygen to your baby’s brain can increase their risk of developing this
disorder.

 Severe maternal malnutrition can also increase their chances of developing it.

Other factors to consider are

1. Craniosynostosis: The brain does not expand because the joints (sutures) between the
bony plates that make up an infant's skull fuse prematurely. In most cases,
craniosynostosis (kray-nee-o-sin-os-TOE-sis) requires surgery to separate the fused
bones. This procedure gives the brain enough room to grow and develop if there are no
underlying issues in the brain.
2. Low oxygen levels in the embryonic brain (cerebral anoxia). Oxygen supply to the
foetal brain might be hampered by pregnancy or birth problems.
3. Infections that are passed on to the foetus when the mother is pregnant. Toxoplasmosis,
CMV, German measles (rubella), chickenpox (varicella), and Zika virus are among
these diseases.
4. Prenatal exposure to drugs, alcohol, or some hazardous substances Any of these can
cause brain problems in your child.
5. Severe malnutrition is number six. Getting enough nourishment throughout pregnancy
can have a negative impact on your baby's development.
6. Phenylketonuria (PKU) in the mother, which is uncontrolled. PKU is a congenital
disorder that prevents the body from breaking down the amino acid phenylalanine.
Characteristics of Microcephaly:
Children with microcephaly may have a variety of symptoms depending on the severity of the
underlying disease.

 Impaired cognitive development,

 Delayed motor functions and speech,
 Facial distortions
 Backward-sloping forehead
 Dwarfism or short stature,
 Hyperactivity,
 Seizures
 Difficulties with coordination and balance
 Other brain or neurological abnormalities.

Some children with microcephaly will have normal IQ and a larger head, but their head
circumference will grow below the usual growth curves.

Diagnosis of Microcephaly:
Doctor will most likely conduct a complete pregnancy, birth, and family history as well as a
physical exam to establish whether your child has microcephaly. He or she will take your
child's head circumference, compare it to a growth chart, then re measure and plot the growth
at subsequent appointments. Parents' head measurements can also be measured to see if their
children have small heads.
Doctor may order tests such as a head CT scan or MRI, as well as blood testing, in some
situations, especially if your child's development is delayed.

After the Birth of the Child

During a physical exam, a healthcare expert will measure the distance around a newborn baby's
head, commonly known as the head circumference, to diagnose microcephaly. After that, the
supplier compares the results to demographic criteria for gender and age. Microcephaly is
described as a head circumference measurement that falls below a specified threshold for
babies of the same age and gender. This microcephaly measurement value is typically more
than two standard deviations (SDs) below the average. The measurement value could also be
labelled as being below the third percentile. This indicates that the baby's head is very small in
comparison to other babies of the same age and gender.
The CDC's growth charts website has head circumference growth charts for newborns, infants,
and children up to the age of 20 in the United States. INTERGROWTH 21stexternal symbol
also offers head circumference growth charts based on gestational age at birth (i.e., how far
along the pregnancy was at the time of delivery). The CDC advises that health care practitioners
in the United States use the WHO growth charts to track the growth of newborns and children
aged 0 to 2 years.
After delivery, the head circumference (HC) can be measured to establish whether or not a
child has microcephaly. Although moulding and other circumstances connected to delivery
may influence head circumference measures, they should be performed on the first day of life
because most birth head circumference reference charts by age and sex are based on
measurements collected before 24 hours of age. The most crucial component is that the head
circumference is meticulously measured and recorded. If the head circumference is not
measured within the first 24 hours of life, it should be measured as soon as possible following
birth. If the doctor suspects that the infant has microcephaly, he or she can order one or more
tests to confirm the diagnosis. Special tests, such as magnetic resonance imaging, can provide
crucial information on the anatomy of the baby's brain, which can aid in determining whether
the newborn baby was infected during pregnancy. They can also assist the healthcare provider
in identifying any other issues that may be present.

Available medical treatments of Microcephaly:

Microcephaly has no known cure. Your child's condition, on the other hand, can be treated. It
will concentrate on dealing with problems.
Occupational therapy may be beneficial to your child if they have delayed motor function.
Speech therapy may be beneficial if their language development is delayed. These therapies
will aid in the development and reinforcement of your child's innate abilities. The doctor may
also prescribe medication to manage certain issues, such as seizures or hyperactivity, if your
kid develops them.
If your child's doctor diagnoses them with this disease, you'll need assistance as well. It's
critical to find compassionate healthcare providers for your child's medical team. They can
assist you in making well-informed decisions.
Prevention of Microcephaly
Microcephaly is not always preventable, especially when the cause is genetic. You should seek
genetic counselling if your child has this problem.
Counseling on genetics
Trusted Source can provide answers and information for a variety of life phases, including
pregnancy planning, pregnancy, child care, and adulthood.
Microcephaly can be avoided by getting good prenatal care and avoiding alcohol and drug use
while pregnant. Your doctor can diagnose maternal disorders such as uncontrolled PKU during
prenatal checks.
According to the Centers for Disease Control and Prevention (CDC)Trusted Source, women
who are considering getting pregnant to follow the same recommendations or at least speak to
their doctor before traveling to these areas.

Question No. 2:
Explain in detail the general strategies for the developmental assessment of children with
possible autism.

Answer:
The Developmental Assessment for Young Children with Possible Autism
A developmental evaluation for children under the age of three aims to evaluate different
aspects of a child's functioning, such as cognition, communication, behaviour, social
interaction, motor and sensory abilities, and adaptive skills. Contextual information is also
provided through assessing the family and the child's environment.

General Strategies for the Developmental Assessment of Children with Possible Autism

Importance of the developmental assessment

Developmental assessments are usually done because of a concern that the child may have a
developmental delay or disorder. It is important to include a developmental assessment when
evaluating children with possible developmental problems because such assessments can:

1. Help identify possible developmental problems and the need for further
diagnostic evaluation

2. Provide an objective description of the child's abilities and deficits (a functional

assessment)

3. Determine eligibility for programs (such as early intervention programs)

 4. Aid in planning for appropriate interventions.

In children who are diagnosed with autism, or in whom there is sufficient evidence to suggest
a diagnosis of autism, it is very important to do a general assessment of all developmental
domains. Because children with autism may demonstrate different patterns of strengths and
weaknesses, it is important to individualize the specific components of a developmental
assessment.

Components of the developmental assessment

It is recommended that a developmental assessment for a young child provide an adequate

functional evaluation of all developmental domains. Important components of a developmental
assessment include the following:

 An objective test of hearing (standardized testing may be less reliable in children under
the age of two)
 Standardized testing of:
o Cognitive ability
o Communication
o Motor/physical skills
o Adaptive skills
o Social, emotional, and behavioral functioning
o Sensory processing
o Curriculum-based assessments
o Observation of the child at informal or structured play and of parent-child
interactions
o Parental interview to elicit their concerns, obtain a history of the child's early
development, and gather information about the child's current level of
functioning
o Review of the child's records (health, education and daycare, etc.) and family
medical history

Process of the developmental assessment

Developmental assessments can be performed by a variety of professionals in a number of

settings and for a number of reasons. Insofar as assessing children with autism is complex,
particularly in children under 3 years of age, it is important that professionals participating in
the developmental assessment have experience and expertise in assessing young children with
autism.

In order to assure quality and consistency, it is recommended that developmental assessments

of young children be performed by professionals with experience assessing young children,
utilize procedures that are reproducible by other professionals and use age-appropriate testing
and scoring methods. It is important the developmental assessment be viewed as an ongoing
process that follows the child over time rather than as a single event.

It is important that the developmental assessment be individualized to the child by:

 Using age-appropriate testing and scoring methods

 Focusing on the child's presenting problems (such as suspected delays or deviations in
development or behavioral problems)
 Assessing specific areas of strength and weakness, including specific discrepancies in
functioning across and within developmental domains

Considering the cultural context of the family

A child's life is embedded within a cultural context. It is essential to consider and respect the
family's culture when assessing children with possible developmental disorders, including
autism. If English is not the primary language of the family, it is important for professionals to
look for ways to communicate effectively with the family, including the use of professionals
and/or translators who speak the child's language.

Considering the assessment setting

When assessing a young child with possible autism, it is important to consider the setting of
the assessment including:

 The presence of parents and the resulting effects on the child's behavior
 The child's familiarity with the environment
 Aspects of the test environment that are distracting

It is recommended that the assessment of the child occur in more than one session and in more
than one setting because the child's behaviors may vary depending on familiarity with the
testing environment and examiner, the child's comfort level with the examiner may increase
over time, a child's behavior can vary from day to day
Using the findings of the developmental assessment

In some cases a developmental assessment to evaluate a suspected developmental problem may

provide professionals with the first indication that a child may have autism. When this occurs,
it is recommended that further evaluation of possible autism be carried out.

It is important to follow up on questionable abnormal findings in the developmental assessment

of any young child. This might include adding elements to the developmental assessment
and/or referring the child to other professionals for more detailed evaluation and specific
diagnosis. It is important that the findings of the developmental assessment be used in
developing any intervention plans for the child. The developmental assessment also provides
useful objective anchor points for monitoring the progress of the child and assessing the
outcomes of interventions.

Communicating findings to parents and other professionals

It is important for professionals assessing children with possible autism to explain the
procedures and findings of the assessment to the parents in terms that are easy to understand.
This would include a full explanation of:

 Important terms and concepts used in reports

 The results and implications of the assessment

 A comparison of the child's performance to developmental norms

Explaining assessment results to parents whose children have autism is particularly important
because the characteristically uneven developmental profile can be confusing. For example, a
child may have age-level nonverbal skills and severely impaired communication skills. It is
important that all professionals involved with the assessment of a child with possible autism
communicate with each other regarding their findings and recommendations.

Assessing Cognition

It is important to assess cognitive ability in children with possible autism because:

 Information about the child's cognitive ability is useful in the diagnostic process,
specifically in differentiating children with autism alone, children with mental
retardation alone, and children who have both autism and mental retardation
  The child's cognitive ability has implications for intervention decisions and has possible
implications for outcome

Methods for assessing cognition in children with possible autism

In attempting to assess cognition in children with possible autism, it is important to assess:

o Verbal and nonverbal cognitive skills as accurately as possible

o The child's ability to use skills and information in everyday environments

In determining the nonverbal cognitive level for a young child, it is useful to observe

o The child's behaviors during structured and free play

o The child's other interactions with people and objects in the immediate
environment

It is important to remember that levels of cognitive skills in young children are sometimes
estimated using a standardized test to derive one of the following measures:

o Developmental quotient (DQ); used mainly for children under 3 years old

o Mental developmental index (MDI); also used for younger children

o Intelligence quotient (IQ); used mainly for older or for more verbal younger
children

Challenges in assessing cognition in children with autism

It is important to recognize that it is often difficult for professionals to accurately assess the
cognitive level of a child with autism. Children with autism often:

o Display uneven levels of skills between different developmental domains

o Have limited language

o Participate in a very limited way in the assessment process

Diagnosing mental retardation in children with autism

Although mental retardation and autism commonly coexist, it is important that professionals
exercise caution in making the diagnosis of mental retardation in young children with possible
autism. It is important that professionals not prematurely label the child as having mental
retardation until appropriate standardized and non-standardized testing of cognition has been
done. It is also important that professionals not infer that the child has a higher cognitive level
than can actually be observed and measured.

Assessing Cognition in Young Children

Definition of Cognition: Cognition includes the processes of the brain that allow us to
experience the environment, remember, think, act, and feel emotions. Cognitive processes are
complex, diverse, and highly inter-related.

Components of Cognition: The components of cognition listed below are particularly

important with respect to autism:

Arousal, orientation, attention, and executive function

Arousal Distributed attention

Orienting Shared attention

Perception Exploration - stimulus seeking

Selective attention Executive functions

Sustained attention

Memory: Short- and long-term memory

Information processing functions

 Pattern recognition
 Facial/emotion recognition
 Processing emotional content
 Imitation
 Cause and effect association
 Deducing rules for responding
 Cross-sensory modality information exchange
 Processing multiple sources of information simultaneously
Reasoning and concept formation

Response flexibility Language

Concept formation Perspective taking

Analogous reasoning Social context and rules

Problem solving

How to Measure Cognition in Young Children

 Standardized testing designed to arrive at a developmental quotient (DQ)
 Criterion-referenced and curriculum-based assessments
 Direct observation

Assessing Communication

It is important to adequately assess communication in children with possible autism because

delayed and/or atypical communication is one of the critical clinical clues in identifying autism.

Assessing communication in children with autism is also important because of these factors:

 Its impact on intervention decisions

 It provides a baseline for monitoring progress
 Its implications for outcome

Components of the assessment of communication

In assessing communication in a young child with possible autism, it is important to evaluate

the child's:

 Hearing status
 Ability to use nonverbal communication strategies (such as, pointing to
request or show an item)
 Atypical or delayed nonverbal communicative behaviors (such as, atypical
eye gaze and gestures)
 Functional use of spoken language (how children use words and sounds to
get what they want)
 Significant delays in onset of spoken language or loss of language
  Atypical communication patterns (such as echolalia, perseveration, and use
of words without apparent communicative intent)

Components of Language: Language is the use of sounds, words, and phrases to verbally
communicate between individuals. Language has the following five main elements:

 Phonology is the sound system of spoken language

 Morphology is the system that governs the structure of words and construction of
word forms
 Syntax is the system governing the order and combination of words to form phrases
or sentences
 Semantics is the system that governs the meaning of words and sentences
 Pragmatics is the system that combines all other language components in
functional use of language
 development measure (such as vocabulary size) that are significantly below the
mean for typically developing children of that age.

Assessing Social Interactions and Relationships

Assessing social interactions and relationships is important in young children with possible
autism because an inability to form social relationships is one of the primary characteristics of
autism.

Assessment of social interactions and relationships includes evaluation of:

 Social initiation (showing or giving objects to others for social purposes)

 Social imitation (imitating actions of others)
 Age-expected reciprocity (turn-taking during play)
 The child's attachment patterns in the presence of a caregiver (neutrality,
excessive clinging, or avoidance of parent)
 The child's tendency for social isolation or preference to be alone
 The child's use of people as tools to obtain desired ends (taking adult's hand
to reach for a toy)
 Social interactions with familiar as well as unfamiliar adults and peers
Assessing Behavior and Responses to the Environment

When assessing young children with autism, it is important to assess their behavior and
responses to the environment because these factors may impact intervention decisions and
provide baselines for monitoring progress. In assessing a child with possible autism, it is
important to identify behavior patterns, relative strengths, and problem areas.

Assessment of a child's behavior and responses to the environment may include evaluation of:

 Behavior patterns and problem behaviors

 Unusual responses to sensory experiences
 Motor skills
 Play skills
 Adaptive behaviors
 Self-help skills

Assessing the Family and the Child's Environment

It is important for the family of a young child with autism to participate in a family assessment
because factors relating to the family can impact intervention and management decisions and
may have implications for outcomes. Assessment of the strengths and limitations of the family
and the child's environment may include observation and/or discussion of:

 The family's stressors, tolerance for stress, and coping mechanisms and styles
 The family's current support systems
 Education experiences of family members
 Family composition, demographics, and specific circumstances
 Family interaction and patterns of discipline
 Emotional expression of family members
 Caregiving skills and sharing of caregiving responsibilities
 Knowledge about autism
Question No. 3:
Discuss some do’s and don’ts for the parents and teachers working on the development
of adaptive skills in children with intellectual disability.
Answer:
Strategies for teaching students with intellectual disabilities:
Intellectual disability, formerly labeled “mental retardation,” is defined by the Individuals
with Disabilities Education Act (IDEA) as “significantly subaverage general intellectual
functioning, existing concurrently [at the same time] with deficits in adaptive behavior and
manifested during the developmental period, that adversely affects a child’s educational
performance.” There are two key components within this definition: a student’s IQ and his or
her capability to function independently, usually referred to as adaptive behavior.
An intellectual disability is not a disease. You can’t catch an intellectual disability from anyone.
It’s also not a type of mental illness, like depression. There is no cure for intellectual
disabilities. However, most children with an intellectual disability can learn to do many things.
It just takes them more time and effort than other children.
Intellectual disability is one of the most common developmental disability, more than 425,000
children (ages 3-21) have some level of intellectual disability and receive special education
services in public school under this category in IDEA. In fact, 7% of the children who need
special education have some form of intellectual disability.

Signs of intellectual disability

 Sit up, crawl, or walk later than other children;

 Learn to talk later, or have trouble speaking,
 Find it hard to remember things,
 Not understand how to pay for things,
 Have trouble understanding social rules,
 Have trouble seeing the consequences of their actions,
 Have trouble solving problems, and/or
 Have trouble thinking logically.
Educational Considerations
A child with an intellectual disability can do well in school but is likely to need the
individualized help that’s available as special education and related services. The level of help
and support that’s needed will depend upon the degree of intellectual disability involved.
General education. It’s important that students with intellectual disabilities be involved in,
and make progress in, the general education curriculum. That’s the same curriculum that’s
learned by those without disabilities. Be aware that IDEA does not permit a student to be
removed from education in age-appropriate general education classrooms solely because he or
she needs modifications to be made in the general education curriculum.
Supplementary aids and services. Given that intellectual disabilities affect learning, it’s often
crucial to provide support to students with ID in the classroom. This includes making
accommodations appropriate to the needs of the student. It also includes providing what IDEA
calls “supplementary aids and services.” Supplementary aids and services are supports that may
include instruction, personnel, equipment, or other accommodations that enable children with
disabilities to be educated with nondisabled children to the maximum extent appropriate.
Thus, for families and teachers alike, it’s important to know what changes and accommodations
are helpful to students with intellectual disabilities. These need to be discussed by the IEP team
and included in the IEP, if appropriate.

Adaptive skills. Many children with intellectual disabilities need help with adaptive skills,
which are skills needed to live, work, and play in the community. Teachers and parents can
help a child work on these skills at both school and home. Some of these skills include:
 Communicating with others;
 Taking care of personal needs (dressing, bathing, going to the bathroom);
 Health and safety;
 Home living (helping to set the table, cleaning the house, or cooking dinner);
 Social skills (manners, knowing the rules of conversation, getting along in a group,
playing a game);
 Reading, writing, and basic math; and
 As they get older, skills that will help them in the workplace.
Transition planning. It’s extremely important for families and schools to begin planning early
for the student’s transition into the world of adulthood. Because intellectual disability affects
how quickly and how well an individual learns new information and skills, the sooner transition
planning begins, the more can be accomplished before the student leaves secondary school.
IDEA requires that, at the latest, transition planning for students with disabilities must begin
no later than the first IEP to be in effect when they turn 16. The IEP teams of many students
with intellectual disabilities feel that it’s important for these students to begin earlier than that.
And they do.
Do

 Observe your child in a wide variety of social situations (e.g., classroom, scout
meetings, free play). This will enable you to gain a deeper understanding of his social
strengths and weaknesses.
 Design an unobtrusive "signal system" with the child to use in social situations. For
example, if the child tends to perseverate (talking about only one topic which often is
not of interest to the listener) design a signal (touch your nose with your finger, cross
your arms) that tells him to change the topic or cease the discussion. In this way, you
can halt troubling behaviors without causing undue embarrassment or conflict.
 Establish reward systems to reinforce and recognize appropriate social behavior. Be
willing to recognize and reinforce even the smallest signs of progress and growth.
 Enroll the child in group activities and pursuits. When selecting these activities,
consider the child's interests and abilities. If you are fearful that the child may be
rejected by the others because of his negative reputation, enroll him in activities in
another neighborhood or town. Thereby, he can begin with a "clean slate".
 Continually reinforce social information. Many social skill deficits are caused by a lack
of basic social information (e.g., all odd numbered houses are on one side of the street;
mayonnaise must be refrigerated; mail deliveries are made only once daily). Never miss
an opportunity to teach this invaluable information to a child. View every car ride or
trip to the store as a "classroom" for social information.
 Encourage all members of the family to assist in the creation of a support system for
the child. Siblings play a particularly important role in such a system. Create a non-
competitive home (and school!!) Environment wherein the child learns to celebrate his
own small victories. The child must learn to view his progress as compared to his own
previous performance, not the performance of others.
 Make transitions easier for the child. Students with social skill deficits often have
difficulty "changing gears" from one activity to another. This is particularly true when
going from an enjoyable activity (e.g., a game) to a less pleasurable one (e.g., math
drills). In order to ensure a smoother transition, be certain to "wind down" the enjoyable
activity by providing a warning signal several minutes prior to the end of the activity.
As each minute passes, inform the child of how much time remains before the activity
will conclude.
  Make modifications and adjustments to accommodate for the child with a learning
problem. For example, if he is unable to participate effectively in the homework
program because he constantly forgets his books, simply issue him two texts with
instructions to keep one at home and one in school.
 Work on one behavior or social skill at a time. By focusing the child's attention and
efforts on a single skill for a period of time, he is less confused and more responsive to
your intervention.
 Assist the child in expressing his feelings during emotionally charged social situations.
(e.g., "i am sure that you feel angry and jealous when daniel and sean go fishing and
don't invite you.")
 Each empathy. Encourage the child to be more understanding of the feelings of others.
Use role playing to help him "walk in another's shoes".
 Utilize "real life" or television shows to teach valuable social skills. Discuss the
behaviors of significant, high status people (e.g., "on that tv show, how did the
policeman make the frightened woman feel more comfortable and at ease?")
 Provide the child with choices whenever possible. (e.g., "i want you to clean your room
now. Do you want to pick up your toys or make up your bed first?") this approach
fosters independence and problem solving skills. It also increases the child's ownership
of the task or activity.
 Provide the child with a positive model of appropriate social skills. Be certain that your
behavior mirrors the skills that you are teaching your students. (e.g., temper control,
courteous listening).

Don't

 Necessarily discourage the child from establishing relationships with students who are
a year or two younger than he is. He may be seeking his developmentally appropriate
level. By befriending younger students, he may enjoy a degree of status and acceptance
that he does not experience among his peers.
 Force the child to participate in large groups if he is not willing or able. If the child
responds well when working with another student, plan activities wherein he has ample
opportunities to do so. Then add a third person to the group, then another and so on,
until the group approximates the entire class.
  Place the child in highly-charged competitive situations. These are often a source of
great anxiety and failure for students with learning problems. Rather, focus upon
participation, enjoyment, contribution and satisfaction in competitive activities.
Emphasis should be placed on the development of skills and strategies - not on winning
or losing.
 Assume that the child understood your oral directions or instructions because he did not
ask any questions. Ask him to repeat the instructions in his own words before beginning
the activity.
 Scold or reprimand the child when he tells you about social confrontations or
difficulties that he has experienced. He will respond by refusing to share these incidents
with you. Rather, thank him for sharing the experience with you and discuss optional
strategies that he could have used.
 Attempt to teach social skills at times of high stress. Rather, approach the child at a
time when he is relaxed and receptive. (e.g.. "meghan, next week you will be going to
jilly's birthday party. Let's practice how you will hand her your gift and what you will
say when she opens it and thanks you.")
 View praise as the only verbal reinforcement - interest works, too! Expressing a genuine
and sincere interest in a child can be as positive and motivating as praise. (e.g.. "i
watched you playing soccer at recess, adam. Do you play at home with your brothers?")
 Encourage the frustrated child to relieve his stress via pointless physical activity (e.g..
Punching a pillow). Rather, teach him to relieve stress through an activity which has
definable and observable goals. (e.g.. Shoot ten baskets, run five laps, write a one-page
letter)

What about punishment?

Don't expect punishment or negative reinforcement to have a meaningful or lasting impact

upon your child's social skill deficits. Punishment may stop specific behaviors in specific
settings, but positive reinforcement is the only effective strategy for meaningful and lasting
social skill improvement.
Overuse of punishment is largely ineffective because:

 it does not teach appropriate behavior- the child merely learns what he should not do;
  the child often becomes passive in the face of punishment and merely avoids situations
similar to those in which he makes social errors (e.g., visiting grandmother, going to
the store);
 the child may develop a concurrent set of inappropriate behaviors, such as lying,
cheating, or blaming others, in order to avoid punishment;
 the child may adapt to punishment, which will require you to intensify the level and
severity of the punishments.

Do use punishment only for behaviors that are intolerable; dangerous to the child or others; and
seemingly unaffected by a well-planned positive discipline approach. Punishment should be
applied immediately following the offending behavior and should be consistently applied. Fair
warning should always be given (e.g., "If you belch again at the table, you will be told to eat
in the kitchen.") Avoid giving a great deal of attention to the child when applying the
punishment and tell him briefly why he is being punished. Avoid numerous threats and never
take away something that you had previously given or promised as a reinforcement for positive
behavior.

Modification for students with intellectual disabilities

Children with intellectual disabilities need some additional support and modifications in their
environment, as well as in the type of activities they do. Here are a few modifications for
students with an intellectual disability that will help them to learn better.
 Quiet Work Space
Using this space only for studying also will help the child get into a routine of studying and
also understand that when he is sitting there, he is supposed to concentrate on the activity or
task, and not play.

 Functional Activities
Teach practical things that will be useful, such as how to boil an egg or how to find their way
to their friend’s house.

 Repetition of Concepts Over the Day

Children with intellectual disabilities need to learn a concept in different ways and have the
opportunity to practice it many times in order to learn and remember it.
  Teacher-Student Ratio
These children require additional support and guidance as they work on their activities. Ideally,
there should be at least 1 teacher for every 3 children with intellectual disabilities.

 Hands-on Learning
Using all the senses to learn also helps them learn and retain information better.
 Safety Measures
Sharp scissors, knives, etc. must be kept out of reach. Harmful liquids like cleaning liquids
must also be kept away. Medicines must be kept out of reach. In addition to this, make sure
that none of the children can lock themselves up in any room. Small beads or other toy parts
that the children could put in their mouth must be kept away if a child has a tendency to do
that. If the child has seizures, you may need to look at padding the corners of furniture to avoid
injury.

 Schedule
The schedule must have short activity times and must alternate between physical and sitting
down activities. The schedule must also try and incorporate some aspects of self-care so that
children start becoming more independent in putting on or taking off shoes, going to the toilet,
or feeding themselves.

Teaching practical tips for special education teachers

 Recognize that you can make an enormous difference in this student’s life!
 Be an active participant in the student’s IEP team.
 Provide accommodations and supports that help students with intellectual disabilities.
 Be as concrete as possible.
 Go step by step.
 Give immediate feedback.
 Help the student learn life skills.
 Address the social aspects of the school.
 Communicate with your student’s parents.
Question No. 4:
What is the difference between mental illness and mental retardation? What methods are
used to diagnose mental illness?

Answer:
Mental Retardation
These are chronic conditions that appear at birth or in childhood, but certainly before age 22,
and sometimes, but not always, occur together. Cerebral Palsy, for example is a physical
disability, which in and of itself does not effect intellectual functioning, though 20-30% of
individuals with Cerebral Palsy also have a cognitive disability. Down Syndrome is the most
common cause of intellectual disability, though levels of impairment vary widely.
In order for someone to be diagnosed with an Intellectual Disability, the person must have a
well below average IQ (70 points or lower) and have severe limitations on daily functioning
skills, which include Conceptual skills, such as language and literacy; Social skills, such as
social responsibility and problem solving; and Practical skills, such as personal care, use of
money, and occupational skills.
Mental Illness:
Also known as mental health disorder or behavioral health disorder, is not the same as
Intellectual Disability. Mental health disorders affect mood, thought processes or behavior and
can manifest in anyone at any time in their life. Mental Illness does not directly impact
cognitive abilities, but can change a person’s perceptions and thought processes and affect a
person’s everyday functioning and ability to relate to others. When mental illness and
intellectual disability occur together, the descriptive term used is “dual diagnosis.”

Diagnosing Mental Health Disorders

Oftentimes, mental health issues co-occur with substance abuse and addiction. Before effective
and appropriate treatment can be given, the mental health disorder first needs to be diagnosed.
The most effective treatment will depend upon the particular cause of the symptoms being
experienced, so it is important that a diagnosis be accurate and thorough.
Diagnosing a mental health disorder is a process, and often includes multiple medical and
mental health professionals. The client should be evaluated not only for a mental health
disorder, but for physical conditions that could be related to the symptoms being experienced.
Many people have more than one mental health disorder, so a thorough diagnosis should
address all the problems an individual faces.
Step 1: Conduct a Physical Exam
A general practitioner or other medical professional is often the first person involved when
diagnosing a mental health disorder. The Merck Manual of Diagnosis and
Therapy recommends that a physical examination be conducted in order to check for medical
problems that might be causing, accompanying, or resulting from a psychological disorder.
Some disorders, such as depression and anxiety, can have physical causes. Thyroid problems
and other physical diseases can sometimes be misdiagnosed as mental health disorders, so this
thorough physical exam is essential. Lab tests are also typically conducted. If a doctor does not
find a physical cause for the symptoms, the client will be referred to a mental health
professional to be evaluated for psychological disorders.

Step 2: Conduct a Psychological Evaluation

Licensed psychiatrists and psychologists can diagnose mental health disorders. A psychiatrist
is a medical doctor who specializes in mental health. A psychologist also specializes in mental
health but does not hold a medical degree. Psychiatrists can prescribe medication;
psychologists cannot. Specialized education and practical experience are needed to be licensed
in both professions.

Mental health professionals typically begin an evaluation by having a conversation about

current symptoms. Often, mental health disorders can be diagnosed through informal
conversations with a therapist. Sometimes, the therapist will administer a more structured
psychological evaluation in order to better determine the correct diagnosis. These evaluations
come in many forms, depending on the specific diagnosis in question. Oftentimes, the therapist
will assess the client’s answers to the particular test’s questions to determine which diagnosis
is most appropriate.

Most psychiatrists and psychologists use the Diagnostic and Statistical Manual of Mental
Disorders, Fifth Edition (DSM-5) to diagnose mental health disorders. This manual includes
criteria for hundreds of different disorders. The therapist or psychiatrist will determine which
criteria fit the client’s condition best.
The disorders in the DSM-5 are broken down into several categories. Mayo Clinic lists the
following categories of mental disorders:
 Neurodevelopmental disorders
  Psychotic disorders
 Bipolar and related disorders
 Depressive disorders
 Anxiety disorders
 Obsessive-compulsive and related disorders
 Trauma-related disorders
 Dissociative disorders
 Somatic symptom and related disorders
 Feeding and eating disorders
 Elimination disorders
 Sleep-wake disorders
 Sexual dysfunctions
 Gender dysphoria
 Disruptive, impulse-control, and conduct disorders
 Substance use and addictive disorders
 Neurocognitive disorders
 Personality disorders
 Paraphilic disorders
It is not uncommon to be diagnosed with more than one mental health disorder. Some disorders
commonly accompany each other, so the treatment professional should evaluate the client for
disorders that are often diagnosed together.

Step 3: Create a Treatment Plan.

Once a diagnosis has been established, a treatment plan should be created. Treatment often
includes a general practitioner, a psychiatrist, and a psychologist or counselor. Each member
of the treatment team should be aware of the diagnoses and treatment methods being used.
Many severe or debilitating mental health disorders require inpatient or residential treatment,
but the vast majority of people who get treatment receive it on an outpatient basis.

Psychotherapy – also called talk therapy – is the most common form of treatment for mental
health disorders. Some disorders can be treated with medication, such as antidepressants, anti-
anxiety medications, and antipsychotics. The most effective treatment typically combines
therapy and medication. Many people benefit from alternative forms of treatment, such as
exercise, acupuncture, yoga, or massage. Mental health professionals can devise a specific care
plan that incorporates the treatments that will most benefit the client.

There are a vast number of methods of psychotherapy that have been supported by research
as effective in the treatment of mental health disorders. The National Institute of Mental
Health lists the following modalities as some of the most commonly used:
 Cognitive Behavioral Therapy
 Dialectical Behavior Therapy
 Interpersonal therapy
 Family-focused therapy
 Psychodynamic therapy
 Light therapy
 Expressive or creative arts therapy
 Animal-assisted therapy
 Play therapy
Some therapists specialize in a specific therapy method, while many combine elements of
multiple methods into their approach. Some diagnoses tend to respond better to specific
methods of therapy. Treatment of mental health disorders is highly individual; what works for
one person may not work for another.
Oftentimes, diagnoses may evolve throughout the treatment process. Symptoms that weren’t
present at the initial assessment may present after all substances have left a person’s system.
As a result, ongoing and regular assessments should be given throughout the recovery process
as the person progresses in therapy. This ensures that the most accurate diagnoses are given
and the most appropriate treatment plan is applied.

Lifestyle and home remedies

In most cases, a mental illness won't get better if you try to treat it on your own without
professional care. But you can do some things for yourself that will build on your treatment
plan:

 Stick to your treatment plan. Don't skip therapy sessions. Even if you're feeling better,
don't skip your medications. If you stop, symptoms may come back. And you could have
withdrawal-like symptoms if you stop a medication too suddenly. If you have bothersome
 drug side effects or other problems with treatment, talk to your doctor before making
changes.

 Avoid alcohol and drug use. Using alcohol or recreational drugs can make it difficult to
treat a mental illness. If you're addicted, quitting can be a real challenge. If you can't quit
on your own, see your doctor or find a support group to help you.

 Stay active. Exercise can help you manage symptoms of depression, stress and anxiety.
Physical activity can also counteract the effects of some psychiatric medications that may
cause weight gain. Consider walking, swimming, gardening or any form of physical
activity that you enjoy. Even light physical activity can make a difference.

 Make healthy choices. Maintaining a regular schedule that includes sufficient sleep,
healthy eating and regular physical activity are important to your mental health.

 Don't make important decisions when your symptoms are severe. Avoid decision-
making when you're in the depth of mental illness symptoms, since you may not be
thinking clearly.

 Determine priorities. You may reduce the impact of your mental illness by managing
time and energy. Cut back on obligations when necessary and set reasonable goals. Give
yourself permission to do less when symptoms are worse. You may find it helpful to
make a list of daily tasks or use a planner to structure your time and stay organized.

 Learn to adopt a positive attitude. Focusing on the positive things in your life can make
your life better and may even improve your health. Try to accept changes when they
occur, and keep problems in perspective. Stress management techniques, including
relaxation methods, may help.

Coping and support

Coping with a mental illness is challenging. Talk to your doctor or therapist about improving
your coping skills, and consider these tips:

 Learn about your mental illness. Your doctor or therapist can provide you with
information or may recommend classes, books or websites. Include your family, too —
this can help the people who care about you understand what you're going through and
learn how they can help.
  Join a support group. Connecting with others facing similar challenges may help you
cope. Support groups for mental illness are available in many communities and online.
One good place to start is the National Alliance on Mental Illness.

 Stay connected with friends and family. Try to participate in social activities, and get
together with family or friends regularly. Ask for help when you need it, and be upfront
with your loved ones about how you're doing.

 Keep a journal. Or jot down brief thoughts or record symptoms on a smartphone app.
Keeping track of your personal life and sharing information with your therapist can help
you identify what triggers or improves your symptoms. It's also a healthy way to explore
and express pain, anger, fear and other emotions.

Question No. 5:
Write short notes on the following:

1. The American Association on Mental Retardation

Answer:
The American association on mental retardation (AAMR) is an interdisciplinary organization
of both professional and others concerned about mental retardation and related disabilities. The
mission of AAMR is to advance the knowledge and skills of professional in the field of mental
retardation throu6 the exchange of information and ideas. The AAMR website is an online
resource to augment the activities of the AAMR and to provide rapid access to information
about mental retardation and development disabilities. The home page provide visitors with
user friendly access to nine different sections. These section include: Directory for this website,
Membership, Periodicals, Publication, Annual Meeting, Training Institute, Career Opportunity,
AAMR Policies and Positions, and Disability Resources. Moving around each page is easy.
Each provides a direct link to the home page and direct access to subsection.

The site provide information for professional interested in research and information related to
mental retardation. Of particular interest are the periodical and publication section. The
Periodical section list the two AAMR produced journals and AAMR produced newspaper with
brief description and subscription information. Direct access is provided to abstract of articles
from the latest issues of each periodical. The publication section provides information on over
38 AAMR publication covering a wide range of topics. Each title includes a brief description
and ordering information. Both of these pages are useful for pediatric physical therapist
wishing to access the latest information on mental retardation. Other useful pages for
professional working with or interested in mental retardation are Training Institute and career
opportunities. The training institute provides information on program available to professional
including the annual AAMR conference. The Career Opportunity section lists career
opportunities for various professional. In addition, available grants and fellowship are also
listed in this section.

AAMR. Strives to advance progressive public policies are the state, national and international
level. The policies and position section describe the various levels of AAMR Fact Sheers,
which are topic of interest to professional working with mental retardation. The fact sheet
provide answer to commonly asked questions. Fact sheet are available on Aging, Human Right,
and Supported Employment.

This sire also provides a list of interest resources in the Disabilities Resources section. Direct
link to several state, regional affiliates are available. There is direct link to organization that
AAMR has working relationship with including: The ARC of United States, The National
Association of Development Disabilities Council, The National Association for Down
syndrome, The National Down Syndrome Society, President Committee on Mental retardation,
and Accreditation Council. In addition, there are direct links to other disability related
resources.

The American Association on Mental Retardation website is easy to move through. It provides
useful information to access current information regarding mental retardation. The site seems
to geared towards professional with journal, publication, programming and career
opportunities. Certainly families with children with mental disabilities can access information
through the site as well as through Links to other sources of information

2. Diagnostic Statistical manual of Mental Disorders

Answer:
The "Diagnostic and Statistical Manual of Mental Disorders" (DSM) is the handbook widely
used by clinicians and psychiatrists in the United States to diagnose psychiatric illnesses.
Published by the American Psychiatric Association (APA), the DSM covers all categories of
mental health disorders for both adults and children.
It contains descriptions, symptoms, and other criteria necessary for diagnosing mental health
disorders. It also contains statistics concerning which gender is most affected by the illness, the
typical age of onset, the effects of treatment, and common treatment approaches.
Just as with medical conditions, the government and many insurance carriers require a specific
diagnosis in order to approve payment for treatment of mental health conditions. Therefore, in
addition to being used for psychiatric diagnosis and treatment recommendations, mental health
professionals also use the DSM to classify patients for billing purposes.

Importance of DSM:

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the handbook used by
health care professionals in the United States and much of the world as the authoritative guide
to the diagnosis of mental disorders. DSM contains descriptions, symptoms, and other criteria
for diagnosing mental disorders. It provides a common language for clinicians to communicate
about their patients and establishes consistent and reliable diagnoses that can be used in the
research of mental disorders. It also provides a common language for researchers to study the
criteria for potential future revisions and to aid in the development of medications and other
interventions.

DSM History

The Diagnostic and Statistical Manual has been updated seven times since it was first
published in 1952.
The newest version of the DSM, the DSM-5, was published in May of 2013
This latest revision was met with considerable discussion and some controversy.

A major issue with the DSM has been around validity. In response to this, the National Institute
of Mental Health (NIMH) launched the Research Domain Criteria (RDoC) project to transform
diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information
to lay the foundation for a new classification system they feel will be more biologically based.

Later, NIMH Director Thomas Insel and APA President-elect Jeffrey Lieberman issued a joint
statement saying that the DSM-5 "represents the best information currently available for
clinical diagnosis of mental disorders." They went on to say that both the DSM-5 and RDoC
represent "complementary, not competing, frameworks" for the classification and treatment of
mental disorders.

DSM-IV-TR Multiaxial System

The DSM-IV was originally published in 1994 and listed more than 250 mental disorders. An
updated version, called the DSM-IV-TR, was published in 2000. This version utilized a
multiaxial or multidimensional approach for diagnosing mental disorders.
The multiaxial approach was intended to help clinicians and psychiatrists make comprehensive
evaluations of a client's level of functioning, because mental illnesses often impact many
different life areas.
It described disorders using five DSM "axes" or dimensions to ensure that all factors—
psychological, biological, and environmental—were considered when making a mental health
diagnosis.
Axis I – Clinical Syndromes
Axis I consisted of mental health and substance use disorders that cause significant impairment.
Disorders were grouped into different categories such as mood disorders, anxiety disorders,
or eating disorders.
Axis II – Personality Disorders and Mental Retardation
Axis II was reserved for mental retardation (a term which has since been replaced by
"intellectual disability") and personality disorders, such as antisocial personality
disorder and histrionic personality disorder. Personality disorders cause significant problems
in how a person relates to the world, while intellectual disability is characterized by intellectual
impairment and deficits in other areas such as self-care and interpersonal skills.
Axis III – General Medical Conditions
Axis III was used for medical conditions that influence or worsen Axis I and Axis II disorders.
Some examples include HIV/AIDS and brain injuries.
Axis IV – Psychosocial and Environmental Problems
Any social or environmental problems that may impact Axis I or Axis II disorders were
accounted for in this axis. These include such things as unemployment, relocation, divorce, or
the death of a loved one.
Axis V – Global Assessment of Functioning
Axis V is where the clinician gives their impression of the client's overall level of functioning.
Based on this assessment, clinicians could better understand how the other four axes interacted
and the effect on the individual's life.
Changes in the DSM-5

The DSM-5 contains a number of significant changes from the earlier DSM-IV. The most
immediately obvious change is the shift from using Roman numerals to Arabic numbers.

Perhaps most notably, the DSM-5 eliminated the multiaxial system. Instead, the DSM-5 lists
categories of disorders along with a number of different related disorders. Example categories
in the DSM-5 include anxiety disorders, bipolar and related disorders, depressive
disorders, feeding and eating disorders, obsessive-compulsive and related disorders, and
personality disorders.

A few other changes in the DSM-5

 Asperger's Syndrome was eliminated as a diagnosis and, instead, incorporated under

the category of autism spectrum disorder.
 Disruptive mood dysregulation disorder was added, in part to decrease over-diagnosis
of childhood bipolar disorders.
 Several diagnoses were officially added to the manual, including binge eating disorder,
hoarding disorder, and premenstrual dysphoric disorder.

While the DSM is an important tool, only those who have received specialized training and
possess sufficient experience are qualified to diagnose and treat mental illnesses.
References:

 Berkell D (ed.). Autism: Identification, Education, and Treatment. Hillsdale, NJ:

Lawrence Erlbaum Associates, 1992.

 Matson JL (ed.). Autism in Children and Adults: Etiology, Assessment, and

Intervention. Pacific Grove, CA: Brooks / Cole, 1994.

 Rutter J, Tuma AH, Lann IS (eds.). Assessment and Diagnosis in Child

Psychopathology. New York, NY: Guilford Press, 1998.

 Schopler E. Mesibov GB (eds.) Learning and Cognition in Autism. New York, NY:
Plenum Press, 1995.

 https://pedsinreview.aappublications.org/content/27/6/204