7/28/2019 Association for Science in Autism Treatment - What is the Relationship Between Autism and Mental Retardation

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Clinician's Corn... What is the rela... ResourcesFAQClinician's CornerForumWhat is the relationship between autism and mental retardation?- Bobby Newman, Ph.D., BCBAQuestion: My four year old child is diagnosed with PDD. A recent evaluatorrecently said that my son was retarded in addition to being autistic. What isthe relationship between autism spectrum disorders and mental retardation? Is myson also retarded?Answer: This can be a very touchy subject, and the answer you get can vary bythe professional you ask. Please understand that my answer reflects my own biasand understanding of the clinical literature on this issue, and I would need agreat deal of information regarding your child to give you an answer that wasspecific to your child.That disclaimer out of the way, in a nutshell, my opinion is that it is entirelypossible that your child may be functioning in the mentally retarded range,without being truly retarded. To expand on what I mean, consider the criteriafor the diagnosis of mental retardation. According to the DSM-IV TR, there arethree criteria for mental retardation:

IQ measured to be two standard deviations or more below the mean.Significant adaptive living skill deficits.Onset before age 18 (in other words, before development is considered to becompleted).

Does your child meet these three criteria? A great many students diagnosed withautism spectrum disorders (ASD) do. My central question, however, is whetherthis measured intellectual deficit is merely a reflection of current behavioral,communicative, and social difficulties. Consider the requirements of standardintelligence tests: They generally require the student to interact with thetester, answer questions, follow directions, imitate, and receptively orexpressively identify requested items. Many students diagnosed with autism havesimply not learned these skills at the time of testing. Following effective

programming, IQ may jump by dozens of points (e.g., Lovaas, 1987). Did youmagically increase the students intelligence, or did you help the individual todevelop the skills that allowed the child to participate in the test? I wouldargue for the latter explanation. Just what is intelligence anyway? Is it somegeneral factor, or a collection of specific factors? A person whose name escapesme once said that intelligence is what intelligence tests measure.Consider another issue: I do some work in Eire, Ireland, and was in the Dublinairport after one of the consulting trips with my friend and colleague MeredithNeedelman (a particularly wonderful speech therapist). She was reading a storyto me from a magazine about some movie star. At one point, Meredith realized Iwas looking at her blankly, smiled and said you have no idea who Im talkingabout, do you? Im afraid I didnt. I couldnt identify 98% of the celebrities

out there if you put a gun to my head. Its just not my area of interest. Callme a cultural illiterate.Why do I mention this? Consider that many students diagnosed with ASD are notexposed to many life experiences that provide the knowledge necessary to answerquestions on the IQ tests. Im thinking of a student I tested a few years ago.When I first met the student, he was not toilet trained, could not speak, andonly consumed Pediasure for nutrition. After a year of very serious effort bystaff and family, all of these deficits were ameliorated, and he was able toparticipate in an IQ test that included a verbal picture identificationcomponent. The child labeled a great many items, but missed others I thought he

7/28/2019 Association for Science in Autism Treatment - What is the Relationship Between Autism and Mental Retardation

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would know. When I went over the results with his mother, I asked if her son hadever seen one of the farm animals on the test. Mom looked at me like I had eightheads, and asked if, considering his former deficits, I thought they were takinghim to petting zoos that frequently. The answer was fair enough, but conditionswere different now. So I called a bunch of people into the room who were a lotsmarter than me (his teacher, speech therapist, and teacher assistants) and weplanned a years worth of field trips that the family and school would take eachweek to expose him to missed experiences. We went over a bridge and through atunnel, to the zoo and an aquarium, to the baseball game, to the ocean, to theforest, and more. I should also mention that on that same intelligence measure,the child scored three standard deviations above the mean on one of the othersubtests that did not directly assess expressive language.To consider the question as regards your son, we need more information. Whatsort of test was used? Did it have verbal and nonverbal components? Was there abig spread among the subtests? Was it a test appropriate for someone of his age?Was the test ever standardized for people with disabilities? Was the testconducted properly? Was the test conducted by someone with whom the student wasfamiliar, and in a familiar setting, or was the test done in such a way that thestudent was not comfortable or motivated?

Was there a measure of adaptive behavior collected? These are often assessmentsthat do not directly test the student, but rather interview significant othersto compare the childs behavior to age-standardized norms. If so, was there aspread among subscales? A large spread, particularly with some subscales in oraround the normal range, would argue against a mental retardation label.Finally, was the adaptive behavior test done properly? I kid you not, I haveheard of such tests being conducted by mailing the questionnaire to parents, acompletely inappropriate use of such measures.I dont want to be glib, but I think the best course of action at present is toact as though the mental retardation diagnosis is simply an artifact ofcontinuing language, interactive, or other skill deficits (as opposed to someinherent and global intellectual delay). Do not speak around your child, asthough he was not in the room. He may be understanding a great deal more than

you realize. Dont think he is too delayed for you to attempt to teachparticular skills. Make sure you teach necessary prerequisite skills, and thengo for it. Students surprise us each day.The late, great Stephen Jay Gould, an annoyingly brilliant individual, oncepublished a book entitled The Mismeasure of Man. The book describes some of thehistorical problems with IQ tests and measures of intelligence in general. Itsuseful background when considering this question.This article originally appeared in an issue of Science in Autism Treatment,the newsletter of the Association for Science in Autism Treatment (ASAT). It maynot be republished or reprinted without advance permission from ASAT. Forreprint permission please contact reprints@asatonline.org Fall NewsletterNow Available Newsletter

Sign up now Site Map Privacy Policy Contact Us P.O. Box 188, Crosswicks, NJ08515-0188 info@asatonline.org Association for Science in Autism Treatment.This article is for personal use only. This article may not be republished orreprinted without advance permission from ASAT. For reprint permission pleasecontact reprints@asatonline.org