Backwardness

The backwardness , or mental handicap , is a deficiency, with various degrees, intellect, faculties mental, Perception and Comportement. It can be associated with others turbid physics or mental or occur separately.

This Handicap of the Personnalité combines various aspects:

medical (genetic, infectious, intoxication, cranial traumatism,…)
social (our environment determines the way of seeing the handicap, compared to the company in which one lives)
cognitive (which is IQ of the person?)
psychological (emotional development).

Terminology

The terms used to define the people presenting a backwardness evolved/moved much during time. At the 19th century, the people having an average or serious delay were described as idiotic or weak , whereas those which presented a light delay were called light weak imbeciles or . The term mongolien , in bond with the physical characteristics associated with the trisomy 21, was also used up to one recent period.

There are not still a clear consensus on (or them) the term (S) to use, to those of “backwardness” and “mental handicap” for example the terms of “mental backwardness” or “intellectual deficiency are added”. The the World Health Organization employs nevertheless the term of backwardness ( mental retardation in English).

The term backwardness can apply only at the time of the schooling; before this period one rather uses the expression delay of the development , when the evaluation of the Intelligence quotient is possible. This evaluation makes it possible to specify the degree of backwardness.

Definition

The the World Health Organization, in its international Classification of the diseases (CIM-10), defines the backwardness as a stop of the mental development or an incomplete mental development, characterized by an insufficiency of faculties and total level of intelligence, in particular on the level of the cognitive functions, language, motricity and performances social.

Degrees

WHO distinguishes 4 degrees from delay:

light delay: IQ between 50 and 69, people knowing of the school difficulties but able to be integrated into the autonomous company of way at the adulthood,
average delay: IQ between 35 and 49, people knowing in the childhood of the important delays of development but of good capacities of communication and a partial independence, with, at the adulthood, required supports of various levels to be integrated into the company,
serious delay: IQ between 20 and 34, people needing a prolonged support,
major delay: IQ lower than 20, people having few capacities to communicate, to move and take care of themselves.

The standard test to evaluate the intelligence quotient is the Test of Wechsler:

the Wechsler Preschool and Primary School Scale off Intelligence (WPPSI-R of 1995) for the 2 year old children 9 months at 7 years
the Wechsler Intelligence Scale for Children (WISC III of 1996) for the 6 year old children at 16 years and 9 months.

However, the scale of Wechsler for adults (wais III for his last version) does not make it possible to measure an IQ lower than 45. The IQ " normal" (statistical standard, is 50% of the population) lies between 90 and 109.

Prevalence

Causes of backwardness

The list of the causes is important. But most of the time the cause will remain unknown. Its research will often require several consultations to follow the evolution of the child and to practice the examinations according to the clinical observations.

Approximately 30% of the cases of backwardness are ascribable to antenatal factors (infections, alcohol consumption) and chromosomal disorders. 20% of the cases are as for them related to environmental factors (stimulation) whereas 15% are explained by perinatal disorders (Anoxie) and postnatal (diseases). The Hérédité is in question in approximately 5% of the cases. However, approximately 30% of the diagnoses of backwardness remain of unknown cause (Morrison, 1995).

Genetic conditions

Disorders transmitted of the relative to the child by genes, at the time of the design.

Syndrome of X fragile

It is about the hereditary cause of the backwardness most frequent, related to the maturation of the gene FMR1 which plays a big role in the development of the brain. The prevalence of this syndrome is from approximately 1 out of 4000 for the men and 1 out of 7000 for the women.

Other backwardnesses related to X chromosome

The Backwardnesses related to X chromosome (known as “RMLX”) form a very mixed group of more than 200 rare diseases which have in common:

a mental deficiency of variable severity
a hereditary feature with risk of several people affected in the same family, mainly of the men.

These delays are expressed various manners and with various degrees: behavior, speech difficulties, motor; school difficulties, relational; deficit of attention…

As many symptoms which require adapted educational programs and which can be associated with other complications: epilepsy, Hypotonia, Hyperlaxité…

Phénylcétonurie

Hereditary syndrome which causes a disturbance of the metabolic system of the amino-acids by causing an accumulation of the Enzyme phenylalanine hydroxylase what results in a loss from growth from the cerebral development. However, the backwardness can be prevented if a suitable mode is respected. The incidence is from approximately 1 case for 15.000 births.

Sclerosis tuberose of Bourneville

Disorder related to a problem of differentiation and migration of the cell S and, all depend on the site of the tubers, aspects different from the development of the person will be reached. Prevalence from approximately 1 case out of 12.000.

Syndrome of Lesch-Nyhan

Syndrome related to the dysfunction of the metabolism of the Purine S what causes an excessive production of Uric acid. The prevalence is very weak, that is to say approximately 1 case out of 100.000 births. Only the boys are reached by this syndrome.

Syndrome of Prader-Willi

Disorder related to chromosome 15, having a prevalence from approximately 1 case out of 15.000 births. This syndrome is divided into two phases. The first spreads out birth until the second year, where the child eats very little and thus has difficulty in take weight. The second phase on the contrary is characterized by an appetite without terminal, which results in a morbid obesity and health issues. These people generally express fits of anger, behaviors obsessifs-compulsifs, irritability, etc

Syndrome of Angelman

Also related to chromosome 15, this syndrome has a prevalence from approximately 1 case out of 12.000. The people presenting this syndrome have a intellectual deficiency engraves as well as an absence of expressive language. Certain physical characteristics (face long, jaw prominent, spaced teeth) and behavioral (nonsuitable laughter, beats of the hands) are related to this syndrome.

Chromosomal disorders

Syndrome of Down

This syndrome is also known under the term of “trisomy 21”. It is the cause of backwardness having the most important prevalence, that is to say 1 birth out of approximately 650. It is important however to specify that the probability of having a trisomic child increases with the age of the mother. Thus, when the mother is old of 20-24 years, the prevalence accounts for approximately 1 case out of 1.450 whereas when the mother is old of more than 40 years, the risks pass to 1 case out of approximately 100.

Problems during the pregnancy

Development of the affected fetus by:

Infections or diseases contracted by the mother during the pregnancy, especially during the first three months. The most detrimental diseases are measles or rubella.
Toxins consumed by the mother (ex: overconsumption of certain fish)
Consumption of certain drugs by the mother

Problems with the birth

Certain complications at the time of the childbirth can involve a backwardness:

Exposure to toxins or infections (ex: genital Herpes)
Trauma undergone by the baby (ex: wound with the head due to an excessive pressure)
Asphyxiation (lack of oxygen, often due to the umbilical cord)

Environmental causes

The factors constitute being able to be controlled by the parents:

Nutrition
physical and sensory Stimulation
physical and psychological Safety
Drug taking and of alcohol during the pregnancy
Medium of life (poverty)
Deficit in Iodine

Prevention

The purpose of the primary prevention is to avoid the appearance of the backwardness. For example, the addition of Iode to the food supports the healthy development of the brain. Also, the increase in folic acid in the food at the time of the pregnancy can help to prevent certain malformations. The advertizing campaigns against the alcohol consumption during the pregnancy to avoid the syndrome of fetal alcoholism are also an good example.

The secondary prevention consists of an intervention aiming at reducing the harmful effects of certain risk factors present, which could result in intellectual deficiency, like suitable programmes of stimulation for certain types of autism.

The purpose of the tertiary prevention is to improve operation as well as quality of life of the people presenting a intellectual deficiency, to prevent the aggravation of deficiency or the development of other problems, like the depression, for example. It also aims at facilitating the acquisition of skills and competences at these people. The role of the educational psychologist can thus form part of this third type of prevention, for example through the programs or the specialized interventions which it carries out in order to improve the condition of the person presenting a intellectual deficiency (Packed & Morin, 2003)

Schooling of the children presenting a backwardness

Classification

Classification according to the minister of education, of the Leisure and the Sport of Quebec

Since the update of its policy of school adaptation, the MELS (2000) defines two categories of pupils in school adaptation. Since this update, the pupils presenting a backwardness are divided into two categories, the category of the " pupils handicapés" including/understanding the pupils having a backwardness of low level of operation (average with deep), while the pupils having a light backwardness are regarded as " pupils with risque". The classification of the MELS reflects the complexity of the universe of the pupils presenting a backwardness. This distribution of pupils with risk and of pupils regarded as handicapped people underlines importance well to distinguish pupils which has a light deficiency intellectual, which is more numerous, of those which have more serious handicaps so that one can answer in manner appropriate to the characteristics of each one.

The MELS defines in its categories of the handicapped pupils, the pupils presenting an average backwardness by indicating that these pupils, in addition to presenting intellectual limitations, have also specific characteristics like difficulties on the plan sensorimotor and linguistic. These pupils need assistance to organize itself at the time of the activities and need framing in the field of personal and social autonomy. The definition of the MELS indicates that the pupil handicapped because of an average intellectual deficiency to severe presents a general operation which is clearly lower than that of average (intelligence quotient which ranges between 20-25 and 50-55) and which is accompanied by deficiencies of the adaptive behavior appearing at the beginning of the period of growth.

Difference between the intelligence and adaptive operation

The Intelligence and the adaptive behavior two are built distinct, although they are related to the theoretical plan. There are first of all a basic difference between methodology of measurement of the intelligence and that of the adaptive Fonctionnement. The intelligence, measured in a standardized context, is often regarded as the potential of the person. The evaluation is done also in an individual context supporting a direct observation of the performance. In addition, the adaptive behavior reflects the observation of the usual performance of the person in her medium of life. The measurement of the adaptive behavior does not refer to a direct observation of the behaviors, but it rather requires the collaboration of the entourage to obtain information on the person. Information comes then from the recall of the former observations of the behaviors emitted by the person. Moreover, the adaptive behavior does not refer to the abstract potential which the intelligence implies. There thus exists a difference between the capacity of the person and her performance. A capacity is described like the skill of a person to carry out an activity; it represents its level of the highest operation. In a way similar to measurement of the intelligence, the capacity must be evaluated in a standardized context. Other side, the concept of performance describes what a person made in her natural environment. The performance can then imply an observation of the interactions of the person with her environment, and represents, in this case, the measurement of the adaptive behavior.

Evaluation of the pupil handicapped by a backwardness

Evaluation according to the minister of education, of the Leisure and the Sport of Quebec

The evaluation answers two very distinct functions. Initially, it has a function of diagnosis for purposes of identification of a pupil who is necessary to his administrative declaration. The diagnosis can be posed only by one professional, but does not involve the administrative declaration automatically. This one is spring of the direction of school which is not obliged to declare a pupil presenting a intellectual deficiency. Then, the evaluation has a function of analysis of the needs for purposes for the development or revision for the plan for intervention for the pupil. It is then a question of evaluating the needs, the forces and the weaknesses of the pupil. These evaluations of update can consist of interviews, observations and test various making it possible to draw up a current portrait of the needs for the pupil. These evaluations of update take less time than the diagnostic evaluation.

The intellectual operation of a pupil is generally evaluated by tests of intelligence or scales of development standardized, validated and standardized. The results of these instruments are expressed in intelligence quotient or quotient of development. The level of adaptive operation, as for him, can be evaluated by measuring instruments the such standardized scales of adaptive behavior, validated and standardized or by a clinical evaluation report.

The prevalence of the Autism and the invading disorders of the development

Since the last decades, the autism and the others turbid invading of the development underwent a big raise in North America and Europe (Wing and Potter, 2002). Despite everything, the prevalence of the invading disorders of the development remains rather weak, it is evaluated with 21 case out of 10.000 in the population (Wing and Potter, 2002), including four times more boys than girls (American Psychiatric Association, 2003). Indeed, between the year 1998 and 2004, the number of children having a diagnosis of invading disorder of the development (TED) provided education for at the school commission of Montreal increased by 337% (School commission of Montreal, 2004).

Which are the reasons likely to explain this fulgurating increase? According to Wing and Potter (2002) several reasons would explain this increase in the prevalence of the pupils having a TED. Firstly, due to the methodological disparity of the studies of prevalence (e.g.: various criteria or diagnostic tools used in the studies), it is difficult to evaluate the real increase in these customers (see also Fombonne, 2003). The changes in the diagnostic criteria also could influence this increase, those having become more inclusive. Indeed, since its appearance in the Diagnosis and Statistical Manual (DSM-III, American Psychiatric Association, 1980), the criteria and the categories diagnostic changed much. Certain categories of disorders of childhood disappeared and others appeared (e.g.: the addition of the invading disorder of the development not specified). The introduction of the concept of the autism as being part of a continuum would have also generated a change in the detection of the TED. Other factors are also likely to have influenced this increase, of which a sensitizing of the population in general and professionals as well as speakers of the medium to the invading disorders of the development. Lastly, the opening of dedicated services for these pupils perhaps also contributed to the increase in the diagnosis (Russet-red, Leroux and Dion, 2005).

Development of the characteristics of the autism of childhood to adolescence

The majority of the people receiving a diagnosis of autism or invading disorder of the development lasting childhood will remain reached throughout their life about it, which also applies for the high level autists or the people being affected by a Syndrome To sprinkle (Seltzer and Al, 2004; Piven and Al, 1996). The symptoms of the autism appear in addition differently during the development of the person (Seltzer and Al, 2003; Wing, 1996; Piven 1996). A heterogeneity of the progression of the characteristics is also observed between the autistic individuals. While some lose skills during time, others reach a plate with adolescence whereas is noticed at some an constant improvement. For those having more progressed, the difficulties with adolescence are similar to those of young people not being reached of a particular deficit (Wing, 1996).

Several retrospective or longitudinal studies showed an significant improvement of the communication of childhood to adolescence (Piven and Al, 1996; Nordin and Gillberg, 1998; Seltzer and Al, 2003). Seltzer and Al, (2003) note in addition that they are the grammatical errors in the speech of the person which decreases, whereas no change is noticed in the use of the gestures to communicate. The skills of language during childhood make it possible to envisage best the psychosocial adaptation to adolescence and the adulthood (To be windy, 1992). The field which lets see less progression is that of the repetitive and stereotyped behaviors (Piven and Al, 1996; Seltzer and Al, 2003). To be windy and Al (1992) showed that although the deficits of the adaptive behaviors persist until adolescence and the adulthood, the intelligence quotient their subjects had increased by 10 points.

Some will sink, with adolescence, during one idle period, characterized by a loss of interests and difficulties of engaging in motor activities and new pastimes (Wing, 1996; Nordin and Gillberg, 1998). Ghaziuddin and Al (2002) suggest that the deterioration of the behaviors observed at certain teenagers would have due to the depressive episodes. Those appear besides more with the comprehension of the social difficulties and are thus more present at those having better cognitive skills (Nordin and Gillberg, 1998; Rogé, 2003). The difficulty of establishing friendly relations is besides a difficulty which persists throughout the life of the autistic individual (Seltzer, 2004; Fullerton, 1996; Wing, 1996).

Evaluation of the pupil presenting an invading disorder of the development

In the Québécois school system, the pupils whose invading disorder of the development was diagnosed see allotting code 50. This diagnosis must be made by a psychiatrist or a pédopsychiatre (MÉQ, 2000). On the other hand, several months can be passed before a child suspected of presenting an invading disorder of the development meets a psychiatrist or a pédopsychiatre. Thus, several school commissions consider the clinical opinion of the educational psychologist to allot code 50 to the child while waiting for the medical diagnosis, so that it is able to receive suitable services during one time of suitable time.

The educational psychologist does not have any biological or medical marker allowing him to evaluate the presence of an invading disorder of the development. It thus falls on to him to observe the child in a way natural or structured using a grid envisaged for this purpose. This one can also use certain tests available. However, the scores obtained with these tests do not make it possible to conclude with an invading disorder in a univocal way.

School integration of the pupil having an invading disorder of the development

The integration of the child reaches of an invading disorder of the development (TED) in ordinary school is a little studied field (Pear tree, Paquet, Giroux and Forget, 2005). However, the deficits implied by the attack of a syndrome such as the autism raise challenges particular to school integration. The restricted social relations, the limitations on the level of the verbal behaviors, the behaviors stereotyped and even sometimes aggressive, particular intellectual operation, the capacity of limited attention, the weak generalization of the assets and the dependence with the primary education stimuli of reinforcement raise some of the difficulties at the time of schooling in ordinary class of pupils TED. However, integration is a service offered to the pupils presenting a TED so that they can receive an education of quality within the most normal possible framework and thus establish contacts with nonhandicapped pars. All these children do not receive this service. There to be able to have access, according to article 235 of the law on the state education, the candidate must initially prove the feasibility of this integration and prove that it “will not have forced there excessive” of the right of the other children (Seneshal, 2002). Also, the placement of the autistic pupil is initially a judgment of the school authorities, the opinion of the parents is not priority in the decisions concerning the choice of the educational medium of their child (Court, Suprême of Canada, 1997; Package, 2006).

In 12 years (of 1990-1991 to 2002-2003), the number of pupils having a code of difficulty 50 with increased by 495% in Quebec and accounted for 10% of the number of pupils having been identified like handicapped (Package, 2006). The investigation of Package (2006), near 110 pupils having an invading disorder of the development, reveals that in Quebec, 60,9% of these pupils attend the ordinary school while 38,2% attend a special school. Those which are provided education for in an ordinary school, only 36,4% are placed in ordinary class and the majority receive a service of accompaniment there. Always according to this investigation, the psychologist offers professional services for 37,3% of the pupils having a TED to the primary education and for 32,1% to the secondary.

Certain authors (Grubar, Trip hammer, Mũh and Roger, 1994; Laushey and Heflin, 2000; Pear tree and Al, 2005) affirm that several pre-necessary is necessary in order to integrate autistic people, without what there is a risk of exclusion. The social integration of the child reaches of a TED at the pars and the teacher of the class of reception is, into different, bond with the capacity to maintain and initiate a social interaction, the imitation, the attention, the intelligence quotient and the level of communication (Garfinkle and Swartz, 2002; Harris and Handleman, 2000; Kennedy and Itkonen, 2001; Rivard, Package and Forget, 2005; Sigman and Capes, 1997; Sigman and Ruskin, 1999; Simpson, Boer-Ott and Smith-Myles, 2003). Also, certain conditions seem to have to be joined together to increase the probability of the success of the school integration of the pupil TED, of which the adaptation of the program of study, training of the teacher of the class of reception, preparation with integration by a program of early intervention intensive, the presence of an accompanying measure and the implication of parents (Pear tree and Al, 2005).

Strategies of school integration

Group of integrated plays
social Scenarios
Accompaniment

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