Riverview Psychiatric Center

Psychology Articles by Dr. Arthur Dingley - Living With Developmental Disability

Dr. Art Dingley

Although children’s brains are injured by accidents, and less commonly by infections or tumors, developmental disabilities are present from birth. The condition is often treatable, but permanent. There are many developmental disorders. This column discusses only three: Asperger’s Disorder, Autistic Disorder, and Mental Retardation.

Asperger’s Disorder causes severe impairment in a child’s ability to interact with others. The child has normal curiosity about his environment, as well as normal intelligence, adaptive behavior, and language acquisition. The impairment of Asperger’s Disorder is from a serious disruption of the child’s ability to relate socially. This disruption results from two types of difficulty.

First, the child is unable to understand, or use, nonverbal social cues. These include making eye contact and using, or “reading”, facial expression, body posture, or hand gestures. Children with Asperger’s Disorder ignore these things. These children have difficulty sharing enjoyment, interests, or achievement with others. They don’t understand how other people feel. They have trouble forming friendships with children their own age.

Second, the child with Asperger’s Disorder has a restricted range of interests. He may become intensely preoccupied with one subject, to the exclusion of everything else. One child with Asperger’s Disorder became completely preoccupied with vacuum cleaners. He collected product information on vacuum cleaners, compared their specifications, wrote to the manufacturers with questions, and talked incessantly about vacuum cleaners, even to people who had no interest in the topic. A child with Asperger’s Disorder may follow detailed, purposeless, routines. He may make stereotyped, repetitive movements like flapping his hands or twisting his fingers. Asperger’s Disorder is more common in boys. Adults with Asperger’s Disorder have continual trouble getting along with others because they disregard normal social cues and have no grasp of how others are feeling.

Autistic Disorder is all over the news these days. Everyone has something to say about it, even (and, perhaps, especially) people who know next to nothing about it. Much of this is driven by junk science. There are many internet websites promoting wiggy ideas about Autistic Disorder. These include the idea that Autistic Disorder is caused by vaccinations, or food additives, or fillings in our teeth. Periodically, the idea re-surfaces that autistic children are mentally normal, just trapped by their inability to talk normally. It would be great if any of this were true.

Autistic Disorder is a severe developmental disability which is always evident before the age of three. Often, it is apparent from infancy. It impairs a child’s interest in the outside world. She is unable to use language effectively. Speech is delayed, rudimentary, or altogether absent. She doesn’t appear to understand questions, directions, or jokes. She cannot carry on a conversation. A child with Autistic Disorder does not acquire written language normally. She does not play games. As a person with Autistic Disorder matures, he shows a very restricted range of interest and may be preoccupied with a few stereotyped behaviors. He may become very attached to a random object or fascinated by moving things. He may insist upon following the same purposeless routine or performing the same ritualistic behavior over and over. She often makes abnormal, repetitive, movements or maintains odd posture.

People with Autistic Disorder often have other problems. At least three quarters of children with Autistic Disorder have mental retardation, and most of that number have an I.Q. between thirty-five and fifty. The child may also have hyperactivity, impulsivity, aggression, self-injury, and temper tantrums. She may swallow inedible objects. She may have no fear of dangerous things.

Autistic Disorder is not common. There are perhaps five cases per 10,000 people. Boys are five times more likely to have this disorder. Special education programs, behavior plans, and, sometimes, medicines are helpful. Young children typically show improvement. Adolescence, however, is the watershed. Although teens with Autistic Disorder may continue to improve, some deteriorate behaviorally. Only a small percentage of adults with Autistic Disorder are able to live and work independently. Even these folks will continue to have marked problems with interaction and will live very constricted lives.

Mental Retardation (MR) is a more common developmental disability. Children with MR have intellectual functioning that is well below average. One standard measure of intelligence is the Intelligence Quotient (I.Q.). Intelligence tests have been designed so that the average score will be 100. About half of the Earth’s population has an I.Q. below 100, and the other half above 100. The majority of people have an I.Q. between 85 and 115. Roughly 94% of people have an I.Q. between 70 and 130, leaving only about 3% at either extreme. The relatively few who score over 130 are “referred to” as gifted. The relatively few who score below 70 are “diagnosed” as having Mental Retardation if they also have significant limitations in communication, self-care, employment, and the like.
Until the early part of the last century, people with MR were classified diagnostically as Morons, Imbeciles, or Idiots. Although we now fling these words as insults, they were not originally meant to be demeaning. Today, MR is classified as Mild, Moderate, Severe, or Profound. About 85% of all people with MR have Mild Mental Retardation. They will be proficient academically at about the sixth grade level, and may be able to live independently as adults with some supervision. About 10% of all people with MR have Moderate Mental Retardation. These folks will acquire very basic (second-grade) academic skills. A person with Moderate MR can be expected to perform simple work, with help, and adapt to community life in a supervised setting, such as congregate housing or a group home. Only about 3-4% of all people with MR have Severe Mental Retardation. These folks may read a few words. They require a good deal of assistance, but can be expected to perform simple tasks. They require close supervision, either by family, or in a group living facility.

Historically, Mental Retardation was often caused by lead poisoning, metabolic defects, poor prenatal care, and maternal drinking. We are getting better at preventing these. Today, in most cases, the cause of MR is not known. However, there are many, many genetic conditions which cause Mental Retardation. The most common of these is Down Syndrome. People with Down Syndrome are often recognizable by their short stature and characteristic facial features. They most often have Mild, or perhaps Moderate MR. Although they are prone to some additional physical problems, these folks do very well with some assistance.

People with MR may have other problems, such as aggression or inappropriate sexual behavior, which challenge caregivers. In addition, people with MR can have the same psychiatric illnesses as anyone else. Diagnosing and treating these psychiatric problems can be tricky, since the necessary information must come from other sources, such as the family, the case manager, and residential, vocational, and day-program staff. It is crucial to get “360 degrees” of input, not just the point of view of one person. There may be philosophical differences among caregivers on what is driving the symptoms or how much latitude the person with MR should have in matters like sexuality or making purchases. When all these parties, including the person with MR, are “on the same page”, a psychiatric problem can usually be identified and treated effectively.

Dr. Dingley is a psychiatrist at Evergreen Behavioral Services in Farmington. He can be reached at adingley@fchn.org

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Psychology Articles by Dr. Arthur Dingley - Living With Developmental Disability

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