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Mental retardation: Linguistic, Prosodic, Behavioural and Literacy characteristics of children with
Mental retardation

Introduction

When we see people around us, we observe that some lack normal physical abilities. For example, there
are people who are unable to see, hear or speak and others who are unable to move around. These people
are commonly known as physically disabled. Similarly, there are people who have poor and insufficient
development of mental functions, including control over their body movements, their intelligence, social
interaction and language, from birth or early childhood. This condition is called mental retardation.

Mental retardation is a term that has been widely used to describe people with less than average
intelligence and behaviour problems. The term "mental retardation" remains the subject of considerable
controversy. Some advocacy groups and professional associations argue that the negative stigma of the
term mental retardation could be avoided by using less loaded language. In 2010, legislation was passed
to eliminate the term mental retardation in favour of "cognitive, intellectual, and developmental
disabilities." However, the usage of the term continues in several journals, textbooks and articles,
although the term ‘Intellectual disability’ is generally more preferred.

Definition

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR)
defines mental retardation as follows:

 Significantly sub-average intellectual functioning - An intelligence quotient (IQ) of approximately 75 or

below
 Concurrent deficits or impairments in adaptive functioning in at least 2 of the following areas:
communication, self-care, home living, social/interpersonal skills, use of community resources, self-
direction, functional academic skills, work, leisure, health, and safety
 Onset before age 18 years

AAMR (2002) ( now called AAIDD- American Association on Intellectual and Developmental
Disabilities), defines Mental retardation/ Intellectual disability as a disability characterized by significant
limitations both in intellectual functioning and in adaptive behaviour as expressed in conceptual, social,
and practical adaptive skills. This disability originates before age 18.

Intelligence
Intelligence refers to a general mental capability. It involves the ability to reason, plan, solve problems,
think abstractly, comprehend complex ideas, learn quickly, and learn from experience. Intelligence is
represented by Intelligent Quotient (IQ) scores. Mental retardation is generally thought to be present if an
individual has an IQ test score of approximately 75 or below. It is important to remember, however, that
an IQ is only one aspect in determining if a person has mental retardation. Significant limitations in
adaptive behaviour skills and evidence that the disability was present before the age 18 are two additional
elements that are critical in determining if a person has mental retardation.
Adaptive behaviour
Adaptive behaviour is the collection of conceptual, social, and practical skills that people have learned so
they can function in their everyday lives. Significant limitations in adaptive behaviour impact a person’s
daily life and affect the ability to respond to a particular situation or to the environment. On these
standardized measures, significant limitations in adaptive behaviour are operationally defined as
performance that is at least 2 standard deviations below the mean of either (a) one of the following three
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types of adaptive behaviour: conceptual, social, or practical, or (b) an overall score on a standardized
measure of conceptual, social, and practical skills.

Classification of Mental retardation

Two descriptive systems that relate to IQ scores remain in use.

The first, Degrees of Retardation, utilizes groups based upon standard deviations below the mean of IQ
scores: Mild: 55 to 75(75%); Moderate: 40 to 55(20%); Severe: 25 to 40(3.5%); and Profound: O to
25(1.5%). This classification system is often used by psychologists, physicians, dentists, and researchers
to indicate the severity of the learning disability.
The second, a Functional Classification, is less concerned with IQ scores and by definition, is related to
the functional level of the person: Educable (EMR) with an approximate IQ range of 40 to 75; Trainable
(TMR) with an approximate IQ range of 25 to 48: and Dependent with an approximate IQ range of less
than 25.2 The term Educable refers to some ability to read and write, although academic achievement of
these individuals is less than that of the general population. The term Trainable refers to the acquisition of
adaptive or self-help skills such as feeding, dressing, toilet training. The term Dependent (or the outdated
term Custodial) refers to persons with mental retardation whose needs will largely be met by others. The
second or functional system, used by special educators and others, relates to the person's ability, with
help, to cope with their learning disability and to participate in education and training programs.

Incidence and Prevalence of Mental retardation in India

According to Census of India (2001) and NSSO (National Sample Survey Organization) (2002), Mental
retardation forms 10% of the total types of disability in India. It is also observed that the incidence is
higher in rural population than urban.

According to S Ganesh Kumar et al., in 2008, the prevalence of mental disability in Karnataka was found
to be 2.3%. The prevalence was higher among females (3.1%) than among males (1.5%). The prevalence
was higher among the elderly age group and illiterates.

Etiological factors of Mental Retardation

The causes of mental retardation can be divided into biomedical, social, behaviour and educational factors
that interact during the life of an individual and/or across generations from parent to child.

 Biomedical factors are related to biological processes, such as genetic disorders or nutrition.
 Social factors are related to social and family interaction, such as child stimulation and adult
responsiveness.
 Behavioural factors are related to harmful behaviours, such as maternal substance abuse.
 Educational factors are related to the availability of family and educational supports that promote
mental development and increases in adaptive skills.
 Factors present during one generation can influence the outcomes of the next generation. By
understanding inter-generational causes, appropriate support can be used to prevent and reverse
the effects of risk factors.

LINGUISTIC CHARACTERISTICS OF CHILDREN WITH MENTAL RETARDATION

Language acquisition is one of the most significant developments, because it represents the integration of
developments in three domains: conceptual, linguistic and social. The child’s conceptual system, which
emerges in the first year of life, is the foundation on which lexical and semantic developments are built.
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The phonological and syntactic systems depend on separate computational mechanisms that are language-
specific. Finally, the pragmatic component, builds on developments in the social domain. There will be
different patterns of development that reflect asynchronies in the semantic, syntactic and pragmatic
aspects of language in children with mental retardation (Tager, Flusberg 1988). Thus, we can say, for
example, that some groups of children with mental retardation will be relatively more impaired in
acquiring syntax, but show relative sparing in pragmatics and semantics ( E.g. in Down’s syndrome:
Fowler, 1990; Miller, 1992). Others will show relative impairment in pragmatics but sparing syntax (E.g.
in Autism: Tager- Flusberg, 1981, 1989). These different patterns of asynchrony reflect the underlying
mechanisms that are specifically impaired in different forms of disability.

What is especially interesting is similar evidence of specific linguistic deficits in persons with MR, as are
often found in DS (Down’s syndrome) (Fowler, 1990) as well as in X-chromosome disorders (Walzer,
1985). Language delay disproportionate to the level of cognitive delay is observed even in persons who
have mild retardation, especially beyond an MA (Mental age) level of 5 years (Abbeduto, Furman and
Davies, 1989). Vig, Kaminer and Jedrysek (1987) studied 38 youngsters with borderline to mild
retardation. When first evaluated at 2 to 4 years of age, 15 had significant language delay below MA
expectations, and 23 scored roughly equivalent on verbal and performance measures. Not only was
general cognition not a reliable indicator of language function at the outset of the study, but it failed to
predict language skill 3 years later.

Studies on Turner’s syndrome (TS) and William’s syndrome reveal domain specificity. 5 out of 6 children
with TS studied by Curtiss and Yamada (1981), revealed normal or advanced language simultaneous with
serious non-linguistic cognitive deficits. Similarly, studies on language development in children with WS,
by Bellugi et al., (1988), reveal a selective preservation of specific cognitive abilities and loss of other
functions.

In summary, most persons with MR achieve language levels either consistent with or more commonly
below MA expectation, suggesting that at least some aspects of language development share common
resources with general cognitive development. However, in some well-studied instances, linguistic
function exceeds or falls dramatically below MA level expectations, suggesting that at least some parts of
language develop independently of some parts of cognition. Notably, the association between MA and
language development becomes considerably weaker beyond an MA of 5 years (Abbeduto et al. 1989).

PHONOLOGY

Phonological difficulties are commonly reported in descriptions of the language of persons with MR, but
few studies have focused on phonology. And most of those have stressed the normalcy of phonological
development. Phonology is crucial in understanding the entire language profile of the person with MR, as
it limits syntactic development either through the role that phonology plays in short term phonological
memory, or that what appears to be a semantic problem may ultimately depend on phonological
representations (Spinelli, 1995).

It has been observed that persons with DS make far more phonological errors than others with MR
matched on MA (Dodd, 1976), and that the errors produced are qualitatively similar to those produced by
much younger children matched on language age (Smith and Gammon, 1983). Further Lebrun and Borsel
(1991), report a 17 year old with DS whose phonological development was poor with phoneme
substitutions and deletions. Prolongations and repetitions were evident in spontaneous speech as well as
in naming and in repetition tasks. According to Cupples and Iacono (2000), difficulty in phonological
awareness is a prominent feature of children with DS.

MORPHOSYNTAX
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Research over the last decade confirms that morphosyntactic development in persons with MR largely
parallels that observed in typically developing children, though often stopping short of full mastery. There
is also evidence of dramatic variation in syntactic skill among similar-IQ persons with MR.

According to a study done by Chapman, Schwartz and Kay-Raining Bird (1991), adolescents with DS
could produce utterances with greater complexity than expected (MLU> 3.0), but omitted more
grammatical function words than peers of the same MA with similar MLUs, thus supporting the specific-
deficit of syntactic expression.

In children with FXS, impaired articulation, sound repetition, telegraphic speech and missing morphology
(poor use of morphemes) were observed (Meyer and Batshaw, 2002).

One of the most striking observations about language in MR is the tremendous variability in linguistic
function within and across subgroups of persons with MR that cannot be attributed to general cognitive
factors. On one hand, as reviewed by Rosenberg and Abbeduto (1993), many adults with mild MR speak
in syntactically complex sentences, with appropriate use of grammatical morphology, suggesting that it is
certainly possible to achieve ultimate levels of grammatical knowledge with limited cognition. Near
normal mastery of morphosyntatcic function (after initial delay) also seems to be the case in WS
(Doherty, 1993), and in rare chromosomal disorders (Ven der Berghe, 1988). On the other hand, it is also
clear that other adults of equivalent cognitive status acquire only limited levels of morphosyntatic
function, as is often reported for persons with DS or Fragile X syndrome (Sudhalter, 1992). Several
distinct hypotheses about morphosyntactic variability in syntactic development have been generated.
These hypotheses attribute morphosyntactic variability to inconsistent application of rules, critical period
factors, or a specific morphemic deficit.

SEMANTICS

Persons with MR apply normal strategies for comprehending sentences and organizing their lexicon, and
often develop extensive vocabularies. Common areas of weakness include abstract vocabulary, relational
terms such as before/after, and idioms, as well as more in-depth knowledge about verbs (Fazio, Johnston
and Brandl, 1993). Semantic knowledge is highly correlated with, and sometimes serves as a measure of,
overall cognitive function.

Cognition and semantics can however, be dissociated, as is made especially salient in recent comparisons
(Bellugi, 1990) of adolescents with DS and WS matched on overall IQ. In adolescents with WS, receptive
vocabulary age exceeded MA expectations; in adolescents with DS it was uniformly below MA
expectations. Differences of semantic fluency were even more striking. When asked to generate names of
animals, the group with DS produced high frequency typical names such as cat and dog; those with WS
generated names such as unicorn, yak and so on. In short, the evidence for spared semantics cuts across
both receptive and productive vocabulary knowledge.

Language acquisition is a challenge for people with DS, although vocabulary level tends to be less
impaired than grammatical abilities (Chapman, Schwartz, & Kay-Raining Bird, 1991; Miller, 1996).
Many children with DS do not acquire their first words before the age of 2 (Rondal, 2001); however, early
lexical development generally shows a positive linear relationship with mental age (Rondal & Edwards,
1997). Individual variation has been reported.
Compared to typically developing individuals matched for mental age, children and adults with DS often
have receptive vocabulary deficits (Jarrold, Baddeley, & Phillips, 2002), although studies have also
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shown some children with DS have similar expressive and receptive vocabulary to typically developing
children of the same mental age (Laws & Bishop, 2003).

PRAGMATICS

‘’Many individuals with Mental retardation are seriously and basically deficient in this area of social
functions’’ (McLean and Synder McLean, 1978). Normally pragmatic functions first become evident with
the development of gestures. The mildly and moderately retarded children with Down’s syndrome exhibit
gestures at the same level of cognitive development of the normal children. But for severally retarded
children, gestures do not appear during initial stages. During later stages, these gestures are often
performed in isolation with little vocalization. Imitation of others and self- repetition may develop
differently for individuals with Down’s syndrome (Sokolov, 1992). Further, children with Mental
retardation are delayed in role-taking and referential communication. Referential communication refers to
a target referent by distinguishing it from others. Such as, ‘‘the boy with a white uniform’’. Further, the
conversational role of the persons with MR seems to be one of non-dominance. The dissociation between
pragmatics and syntactic abilities (with varying cognitive abilities) has been studied by Cromer (1991).
He quotes examples of persons with DS, autism and schizophrenia to explain this dissociation. The reason
for this dissociation, he says, is that ‘‘it seems clear that the ability to communicate in a social setting
depends on different cognitive skills than the acquisition of language’’.

Laws and Bishop (2004) reported pragmatic language impairment and social deficits in a group of older
children and young adults with WS, using the Children’s Communication Checklist (Bishop, 1998). The
checklist ratings showed pragmatic language deficits, evident from inappropriate initiations of
conversation, and use of stereotyped conversation. However, there have been reports that good social
communication skills are a “hallmark” of Williams syndrome (Jones et al., 2000). Jones et al. (2000)
argued that superior social-communication skills distinguish this population from populations with other
developmental disorders, such as autism. Fidler, Philofsky and Hepburn (2007) report that children with
WS have difficulty in some areas of pragmatics such as the use of context to interpret or modify language,
inappropriate requests and lack of integration of the knowledge of their conversational partner.

PROSODIC CHARACTERISTICS

Segmental aspects of speech sound production concern a speaker's articulatory precision.

Suprasegmental aspects of speech production, or prosody, are concerned with those properties of the
speech signal that modulate and enhance its meaning. Prosody functions at several levels to enable
speakers to construct discourse through expressive language. Crystal (1986), Kent and
Read (1992), Merewether and Alpert (1990), and Panagos and Prelock (1997) provide various accounts of
these levels, which can be categorized in three sub-domains.

Grammatical prosody includes suprasegmental cues that are used to signal syntactic information within
sentences (Warren, 1996). Stress can be used grammatically within words to signal, for example, whether
a token is being used as a noun (pre'sent) or a verb (present'). Pitch contours signal the ends of utterances
and denote whether they are questions (rising pitch) or statements (falling pitch). Grammatical uses of
prosody are generally obligatory aspects of the production of the surface structure that are an inherent part
of the transformation from deep structure meanings (Gerken, 1996; Gerken & McGregor, 1998).
Pragmatic prosody is used to carry social information beyond that conveyed by the syntax of the
sentence. It conveys the speaker’s intentions or the hierarchy of information within the utterance, and
results in optional changes in the way an utterance is expressed (Van Lancker, Canter, & Terbeek, 1981;
Winner, 1988). Stress, as one example, can be used to highlight an element of information within a
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sentence as the focus of attention. This pragmatic use of stress usually referred to as emphatic or
contrastive stress, calls the listener’s attention to information that is new to the conversation, unfamiliar,
or unexpected within the sentence. Emphatic stress is used to highlight the comment or predicate of an
utterance, the portion that elaborates on the topic established within the discourse (Bates & McWhinney,
1979; Haviland & Clark, 1974).

LITERACY CHARACTERISTICS

Literacy skills of children with MR are not the same as children with other special needs due to limited
intellectual capacity. However they can use numeracy and literacy skills to some extent which are
application oriented if they are given appropriate training.

Children with mild mental retardation also termed as ‘’educable’’, can master the basic communicative
skills for near-independence in our society, i.e., a grade-school vocabulary, and ability to read and write
to the extent that they can read signs, labels, and simple directions. Arithmetic is learned to the extent that
they can go shopping and perform measurements (Rizopoulos & Wolpert, 2004).

Characteristics of children with mental retardation vary widely. Children with MR may have difficulty
with expressive language, poor short-term memory, low level meta-cognition skills, and poor use of logic
and organization. Some children with MR also have motor difficulties that can affect their handwriting or
their ability to hold reading material steadily (Rizopoulos & Wolpert, 2004).

BEHAVIOURAL CHARACTERISTICS

With the following exceptions, there are no specific behavioural characteristics that are common to all
individuals with mental retardation: (a): hyperactivity, distractibility, short-lived aggression, destructive
behaviour, poor self control (lack of inhibition), erratic and impulsive behaviour; (b) affection seeking
and stubbornness that are sometimes associated with Down Syndrome; and (c) behaviours associated with
the emotional and psychological problems that sometimes accompany retardation (Patton, J. R. et al.,
1986).

The population with MR is considered to be more concrete in thinking and often lacks the ability to
generalize from one stimulus to another. Because persons with mental retardation have difficulty in
predicting outcome, changes in routine can create behavioural instability. Perseveration (continued,
meaningless repetition of words, phrases or certain physical movements) may be characteristic of some
individuals with MR, especially those who are brain damaged. In addition, their experience and
expectation of failure compared to success greatly influences the intellectual development of the person
with mental retardation.

Typically viewed in positive behavioural terms, children with DS have been described as affectionate,
sociable, amiable, outgoing and controllable (Gun and Berry, 1985). Although some children can show
stubbornness, conduct disorder and attention deficit (Meyers and Pueschel, 1991), especially early in life,
youngsters with DS appear to be less prone to serious behaviour problems.

Reference

V Reed (20013). In Introduction to Language Development.