ISSN : 2241-4665
ISSN : 2241-4665
Ημερομηνία έκδοσης: Αθήνα 27 Ιουνίου 2018
Η παρούσα μελέτη αποτελεί τμήμα της διδακτορικής μου διατριβής που πραγματοποίησα το 2013. Η μελέτη αναφέρεται στη νοητική υστέρηση, μία παθολογική κατάσταση, η οποία εμφανίζεται κατά την περίοδο ανάπτυξης του ατόμου.
This study is part of my doctoral dissertation in 2013. The study refers to mental deficiency, a condition that occurs during the person's development.
Mental deficiency is conceived as a global deficiency which targets the entire personality, structure, organization, intellectual, affective, psycho-motor, behavioural-adaptive, hereditary or acquired development, due to an organic or functional lesion of the central nervous system, manifested in the first years of life in different degrees of severity relative to the average population level, with direct consequences in terms of the social-professional adaptation, personal and social competence and autonomy.
The complexity of this psychic dysfunction is also obvious in the plurality of notions used with the same meaning: mental backwardness, oligophrenia, mental retardation, developmental delay, intellectual disability, mental impairment (apud Radu 1999).
J. de Ajuriaguerra (apud Radu 2000) states that "in order to reach a useful definition, it is necessary to bring together a great deal of information: biological, socio-cultural, emotional, without which we cannot conceive the temporal and spatial dimensions of personality. (...) the concept cannot have an absolute value as long as we use only one criterion.
R. Zazzo (Zazo 1979) affirms that: „feeble-mindedness is the first area of mental impairment - relative impairment to society's demands, variable requirements from one society to another, from one age to another - an impairment whose determinant factors are biological and with irreversible effect in the current study of knowledge".
According to Gh. Ionescu (apud Radu 2000), the definitions of mental deficiency can be grouped into three categories:
a) Structural-etiological definitions;
b) Functional-asserting definitions;
c) Operational-behavioural definitions.
A.R. Luria (apud Radu 2000) considers mental deficiency as "a serious brain involvement of the child before or during the first childhood, which causes a disturbance of the brain's normal development and numerous anomalies of mental development".
J. Lang (apud Radu 2000) states that mental deficiency corresponds to an impossibility or insufficiency (impairment) of functioning, capability or functional organization.
The American Association on Intellectual and Developmental Disabilities considers that mental deficiency refers to an under-average functionality of general intelligence that originates in the development period and is associated with disorders of the adaptive behaviour (Radu 2000).
A difficult problem is the classification of mental deficiency, taking into account the wide variety of clinical forms and types, the wide range of aetiology and the extremely rich symptomatology.
Using the term of amentia (the absence of intelligence), A. F. Tredgold (1908, 1922, 1929, 1937), classifies it into 4 groups (apud Radu 2000):
· Primary amentia (intellectual deficit is caused by hereditary heritage)
· Secondary amentia (extrinsic deficit)
· Mixed amentia
· Amentia without direct detected cause.
In fact, he introduces the dichotomy:
· Endogenous debility
· Exogenous debility later also used by other authors such as: Laresen (1931), Lewis (1939), Werner (1934), Stromm (1969) (apud Radu 2000).
Matty Chiva (1973) (apud Radu 2000), transfers this classification into:
· Normal debility
· Pathological debility.
According to M.S. Pevzner (apud Radu 2000) there are 4 categories:
· Primary or basic oligophrenia;
· Oligophrenia with significant perturbations of the cortical neurodynamics;
· Oligophrenia with perturbation of basic nervous processes;
· Oligophrenia with notable deficiencies of the frontal lobes;
The classification of intellectual disability is also based on the measurement of the intelligence quotient (by means of tests), the psychological development quotient, the evaluation of the possibilities of adaptation and integration, the formation of personal autonomy, the elaboration of the communicational and relational behaviours.
The best-known classical psychometric scale for determining intelligence is that of Terman and Merill (apud Radu 2000). They classify the mentally-impaired into the following categories:
0 – 24
25 – 49
50 – 69
70 – 79
80 – 90
Gradually using the term of mental debility, Ursula Şchiopu and Emil Verza (1994), propose the following classification of mental retardation:
· Mild debility - IQ: 50-85
· Moderate debility - IQ:35-50
· Severe debility - IQ: 20-25
· Deep debility - IQ: sub 20
Among these children may appear the so-called scholar idiots - that is, mental retards with some skills that underlie remarkable performances (for example, mathematical computing performance).
Four degrees of severity can be specified, reflecting the level of intellectual deterioration: mild, moderate, severe and deep.
· Mild mental retardation - IQ level from 50-55 to approximately 70
· Moderate mental retardation - IQ level from 35-40 to 50-55
· Severe mental retardation - IQ level from 20-25 to 35-40
· Deep mental retardation - IQ level below 20 or 25
· Mental retardation of unspecified severity can be used when there is a strong presumption of mental retardation, but the person's intelligence cannot be tested by standard tests (for example, in too-impaired or uncooperative individuals or in infants).
The mild mental retardation is largely equivalent to what is used to refer to the educational class as "educated ". This group is the largest (almost 85%) segment of those with this disorder. Considered as a group, these individuals with this level of mental retardation typically develops social and communication skills during preschool (0-5 years), have a minimal impairment in the sensory-motor areas, and often do not differ from children without mental retardation until later. By the end of their adolescence, they can acquire appropriate schooling skills around the level of the sixth grade, during the adult period they usually acquire appropriate social and professional skills for a minimum of self-care, but may require supervision, guidance and assistance, particularly in conditions of inhabitual economic or social stress. With the right support, individuals with mild mental retardation can, as a rule, live successfully in the community, either independently or under supervision.
The moderate mental retardation is largely equivalent to what is used to refer to the educational category of "trainable." This out-dated term should not be used because it mistakenly implies that people with moderate mental retardation cannot benefit from educational programs. This group accounts for almost 10% of the entire population of people with mental retardation. Most individuals with this level of mental retardation acquire early communication skills in the young childhood. They receive professional training and, with moderate supervision, can participate in their own personal care. They can also benefit from training in social and professional skills but are unable to progress beyond the second grade in terms of schooling. They can learn to travel independently through familiar places; during adolescence, their difficulties in recognizing social conventions can interfere with relationships with peers, in the adulthood, most are able to perform unskilled or semi-skilled work under supervision in protected workshops or in general labour. They adapt well to community life, usually under supervision.
The group of those with severe mental retardation accounts for 3% - 4% of the total number of individuals with mental retardation. In their young childhood, they acquire very little or no communicative language, during the schooling period, they can learn to speak and be trained in elementary self-care skills. They benefit only in a small amount from pre-school education, such as alphabet and numeracy familiarization, but they can acquire skills such as learning to read at first glance words of "survival"; in the adulthood period, they may be able to perform simple tasks, under strict supervision conditions. Most people adapt well to life in the community, in their homes or in their families, unless they have a disability that requires specialized nursing or other type of care.
The group of individuals with deep mental retardation accounts for approximately 1% - 2% of the total number of individuals with mental retardation. Most individuals with this diagnosis have an identified neurological condition that justifies their mental retardation during their young childhood; they have considerable impairments in the sensory-motor function. Optimal development can occur in a highly structured environment with constant help and supervision and a personalized relationship with a nurse. Motor development, self-care and communication skills can improve if a proper training is provided. Some can perform simple tasks under strict protection and supervision.
Diagnosis of mental retardation of unspecified severity should be used when there is a strong presumption of mental retardation, but the person cannot be tested successfully with standard intelligence tests. This may be the case when children, adolescents or adults are too impaired or non-cooperative in testing, or in the case of infants when there is a clinical judgement of significantly below average intellectual activity, but the tests do not provide IQ values (for example, the Bayley Scales of Infant and Toddler Development, Cattell's scales assessing the infant's intelligence and others). Generally the lower the age, the more difficult it is to assess the presence of mental retardation, except in cases of deep deterioration.
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