Severe Behavior Disorders In The Mentally Retarded

It is well known that behavior problems are a salient characteristic of children and adults with mental retardation. That is not to say that all persons with mental retardation experience behavior disorders; how ever, most studies indicate that the incidence of emotional disturbance in this population is four to six times greater than that observed in similar intellectually nonhandicapped children and adults. It is equally well known that the principal form of treatment accorded clients with mental retardation and behavior disorders is pharmacotherapy or the prescrip tion of behavior modifying drugs. Recent studies show that 6 out of every 10 individuals with mental retardation have been prescribed drugs as treatment for disorders of emotion or behavior. Unfortunately, further studies indicate that only one or 2 out of every 10 clients receiving medication are determined to be "responders," such that some thera peutic benefit is derived from their drug treatment. As noted by the title, the single major thrust of this volume is to review approaches to the treatment of behavior disorders in persons with mental retardation from a nondrug perspective. This requires the presentation of a wide range of material on treatment: basic behavior modification programming, cognitive-behavioral strategies, habilitative approaches, counseling and psychotherapy, designing therapeutic living environments, managing medical factors bearing relevance to emotional illness, intervening with families, training special education teachers and direct care staff, and supplying information on the client's rights to obtain treatment in the least restrictive and least intrusive manner.

In late 1985, The President's Committee on Mental Retardation (PCMR) spon sored a National Strategy Conference on Mental Retardation and Mental Health in Washington, D.C. The purpose of this conference was to bring together our nation's leadership in the fields of mental retardation and mental health in order to delineate the state of the art relative to the diagnosis, care, and treatment of citizens with mental retardation/mental illness, as well as to chart a national course for the support and integration of citizens with these challenging needs into the confluence of family and community life. The President's Committee on Mental Retardation recognized that citizens with these needs constitute one of the most underserved and, at times, forgotten segments of the population. With this in mind, the PCMR called together govern mental, professional, and parental representatives from across the nation to define the nature and extent of the problem, programs, and services that promise hope for substantive improvement in the quality of life of citizens with mental retardation/mental illness.

The development of behavior modification principles and procedures and the ensuing research have had a dramatic impact on services for mentally re tarded persons. This book is the second edition of a volume that is designed to update readers on some of these many developments. Although many of the chapter titles and authors from the first edition remain unchanged, we have added additional chapters to reflect new areas of research. The book is thus a critical review of this literature and, as such, provides essential and important notions about what we know and what can be done to expand our current knowledge. The authors of the chapters are all recognized experts who have been active in publishing in the research areas they critique. As a result, they have a good understanding of what are the major issues in the field. And because they are also active in service provision to persons with identified handicaps, their material will be especially useful to practitioners and, it is hoped, to those_ professionals who are working in the field in estab lishing data-based treatments. One important change in the field has concerned the terminology used to We are aware that persons with mental retar describe handicapped persons. dation are no longer referred to as "the mentally retarded," and although no disrespect is intended, for the sake of continuity the original title has been retained on the advice of the publisher.

Since the 1970s, the development of normalization philosophy and the implementation of community care policies have highlighted the nature and treatment of psychiatric and behavior disorders in people with mental retardation and rekindled the interest of scientists, psychiatric practitioners, and service providers. With these changes has grown a substantial body of new research and information on the phenomenology, epidemiology, classification, and clinical features of mental illness and behavior disorders in mentally retarded persons. In response to this growing interest and awareness, the editors, together with internationally renowned contributors from the United States and Europe, have compiled the first comprehensive handbook of the current theory and practice of mental health treatment and care in mentally retarded children and adults. Both contemporary and in-depth, this multidisciplinary, multidimensional volume covers all available therapeutic methods, including psychopharmacotherapy, psychotherapy, behavior therapies, cognitive therapy, and the systems approach for all the main diagnostic disorders in people with mental retardation. Parts I and II present an overview of epidemiology and clinical presentation, including research trends, and therapeutic methods, including psychotherapy, psychopharmacology, behavioral therapies, cognitive and social learning treatments, and working with families and caregivers. Parts III and IV focus on psychotherapeutic interventions, such as rational emotive group treatment with dually diagnosed adults, pre-therapy for persons with mental retardation who are also psychotic, and systemic therapy, and how to apply these methods to the treatment of specific mental illnesses, such as schizophrenia, epilepsy, and mood and anxiety disorders. Parts V and VI discuss how to treat behavior disorders such as aggression/self-aggression (pharmacotherapy and strategic behavioral interventions) and self-injurious behaviors (multimodal contextual approach), including group therapy for sex offenders and a pedagogical approach to behavior problems, and which treatment methods, such as psychodynamically oriented psychotherapy and pharmacotherapy, are most effective with children, including developmental-dynamic relationship therapy with more severely mentally retarded children. Parts VII and VIII provide guidance on mental health services and staff training, including psychiatric treatment in community care and a model for inpatient services for mentally ill persons with mental retardation, and the editors final chapter, which draws together all the various therapeutic approaches described in previous chapters to provide a practical framework for an integrative approach. Filling a major gap in the literature, this indispensable resource for psychiatrists, psychologists, and educators working with mentally retarded persons is also intended for general practitioners, doctors, social workers, and therapists working in the same or related fields.

Problem behaviors often compound the already difficult task of improving the lives of persons with severe disabilities. This important volume, representing the culmination of more than a decade of clinical research, presents the first complete description of the procedures used in Functional Communication Training--a positive approach for reducing severe behavior problems. The procedures described in this book have been validated by numerous empirical studies for use with children, adolescents, and adults who display behaviors as diverse as aggression, self-injury, tantrums, and bizarre, psychotic speech. Functional Communication Training involves teaching students how to communicate those basic wants and needs that they have previously sought to have fulfilled via their problem behavior. They are taught to replace their challenging behavior with learned communication skills. This book provides the practitioner with step-by-step instructions for implementing this effective approach. A variety of assessment strategies are reviewed and described to assist in determining appropriate interventions. The Motivation Assessment Scale--one device designed to assess the function of problem behavior--is outlined in detail and is accompanied with guidelines for its administration and interpretation. Communication training is then detailed and illustrated using speech, sign language, and augmentative systems as examples. Numerous case examples throughout illuminate both the assessment and intervention strategies. Providing clear direction for ameliorating complex behavior problems, this book will be valued by psychologists, behavior analysts, special educators, and speech and language therapists. It can be used as a text for advanced undergraduate courses on behavior management in psychology and special education, and also serves as supplementary reading for courses on behavior modification or mental retardation/developmental disabilities.

A survey of the instruments and methods that are available for assessment of psychopathology and behavior problems in persons with mental retardation. Instruments are described and evaluated from a methodological perspective.