Selected notes on the field of diagnosis of adults with mental disabilities

Selected notes on the diagnosis of adults with mental disabilities The following text was created as one of the outputs of the Specific Grant Competition held at the Palacký University in Olomouc in 2013. The material obtained from it, both theoretically and practically, will subsequently be used in the dissertation. In the presented article, only selected data from two groups of respondents are available. The area of ​​the diagnostic process is viewed here from the position of psychologists and social workers or persons who work with adults with mental disabilities.

Diagnosis of adults with mental disabilities is the domain of special education, specifically its young part of special education andragogy (hereafter referred to as SPANDR). Krejčířová, Vymazalová, Hublar (2011) understand SPANDR as a young discipline, the development of which is related to the transformation of the paradigm of special pedagogy as a whole. In agreement with the authors Csefalvay, Lechta 2013, it can be paraphrased that one of the tasks of SPANDR is also to refine its terminological apparatus and build an adequate position in the system of sciences. This process also closely corresponds to the elaboration (or further verification) of sub-structures of the discipline in general. Diagnosing adults with mental disabilities is an infrequent topic due to the absence of erudite experts, adequate work and the sensual output of this process for the mentioned group of people. In the Czech Republic, Mgr. Martin Lečbych, Ph.D. but exclusively as a psychological phenomenon.

At the beginning of the text, we consider it necessary to define the terms that will be dealt with in the text, namely mental retardation, mental disability and diagnosis. Bajo, Vašek (1994) define mental retardation as "a general term that includes a certain form of disturbed ontogenetic development. It is about negative deviations from the norm at the level of intellectual functions, then also in learning and social development". Švarcová (2006) perceives mental retardation more narrowly as a significant reduction in intellectual development. Mental retardation can be understood as a "developmental mental disorder with reduced intelligence, demonstrated by a reduction in cognitive, movement, speech and social skills with prenatal, perinatal and postnatal etiology (Valenta; Müller, 2009). To determine the limit of mental retardation, the measurement of an intelligence quotient of less than 70 was indicated (Valenta, Kozáková, 2006). From a terminological point of view, it is now being withdrawn from use of this term and it is replaced by the phrase mental retardation.

Another term used in Czech special education practice is mental disability. Some authors may consider both mentioned terms as synonyms (Černá, 2009), although they will be understood differently within the text, but due to respect for terminological correctness, the phrase mental disability, which is perceived as an umbrella term, will be used. Mental disability is a broader phenomenon that includes people with a measured IQ of less than 85 (Valenta, Kozáková, 2006). From the point of view of special pedagogic practice and theory, persons with mental retardation, persons after injuries, persons with dementia or persons with organic psychosyndrome can be included in the mentioned category, which currently represent a large part of the special pedagogic and andragogic clientele.

Last but not least, it is necessary to mention the concept of diagnosis. Vašek (2006) understands the diagnostic process as obtaining information about the course, conditions and results of education and teaching of disabled or non-disabled individuals and determining the effects of disabilities on their educability and educability. The authors Valenta, Müller (2009, p. 61) define diagnosis somewhat more broadly, according to them, it mainly works with "recognizing the conditions, means and effectiveness of education and social therapy and enculturation of clients with mental disabilities."

Due to the need to respect the complexity of the diagnostic process (cf. Valenta; Müller, 2009, Černá, 2009), other professionals should also participate in its implementation. Their composition can be derived from the teamwork of experts who oversee the diagnostic process in children. As well as children's clientele, the methods and tools of psychology, pedagogy and special pedagogy are used. The goal is to ascertain the current level of the individual (in terms of various areas) and to determine the direction in which subsequent intervention should be taken. Since the diagnostic process takes place mainly in children (screening is carried out by a special education center), a pediatrician, a child neurologist, a child psychiatrist, a psychologist from a pedagogical psychological counseling center, and a clinical geneticist participate in this process (the cause of mental retardation is unknown in 50% - 75% of cases). From the point of view of an adult, the diagnostic team should represent:

• the person with a mental disability himself,
• psychologist,
• special pedagogue (special pedagogue – andragogue),
• key worker/personal assistant,
• doctor,
• social worker/social pedagogue,
• family.

The position of an adult with a mental disability is significant in terms of the possibility of communicating their expectations, wishes and interests. Information from the family environment is essential as a source of anamnestic data, but also from informal groups of which an adult person with a mental disability is a member. From the point of view of diagnostics in adulthood, social diagnostics, which covers the above-mentioned areas, provides key data. It is often a social worker who comes to the individual's natural social environment for the purpose of social investigation and can provide valuable information on this basis. Another participating expert should be a psychologist who focuses on individual components of personality. A special pedagogue uses special pedagogic procedures and techniques applicable to adults with the appropriate type and degree of disability.

With regard to the diagnosis of mental retardation, two classification systems are used worldwide. The first of them is the International Classification of Diseases 10th revision (hereafter referred to as ICD 10) and the Diagnostic and Statistical Manual of the American Psychiatric Association V (hereafter referred to as DSM V). The 10th revision of the International Criminal Code has been valid on the territory of the Czech Republic since 1994. Due to its relatively long validity, an amendment was added in the last year. The last amendment took place with effect from January 1, 2013. According to the Ministry of Health, a complete update of the ICD is planned for 2015. Available from WWW: . DSM V was amended in 2013, it applies mainly in the United States of America. In ICD 10, mental retardation is divided into the following areas:

• slight mental retardation,
• moderately severe mental retardation,
• severe mental retardation,
• profound mental retardation,
• other mental retardation.
• unspecified mental retardation.

In older literature, the category of mild mental retardation also appeared in the measured IQ range of 70-79, but it is not listed in the classification systems. DSM V presents a similar breakdown:

• slight mental retardation,
• moderately severe mental retardation,
• severe mental retardation,
• profound mental retardation,
• unspecified mental retardation. (Černá, 2009)

The goal of diagnosis in adulthood should be to find the area of his individual specific needs, try to fulfill them and enable optimal participation in life in society. Strengths need to be identified for special pedagogical practice, but shortcomings are defined in practice, which are also mentioned in the resulting reports. Due to the minimal implementation of the diagnostic process in adulthood and its analogous application to adults, this aspect also appears in adulthood. And that despite the fact that each of us is constantly developing and changing throughout our lives. At the same time, the skills of each person can then be developed into elements that can be built on as part of the intervention. The diagnostic process for adults with mental disabilities mainly monitors the following areas:

• how a person coped with his own disability (here there is a significant difference between congenital and acquired disability. It is assumed that acceptance of disability is more difficult for the type acquired during life),
• how did the presence of a disability affect the nature of the environment in which a person lives (family, friends)
• how does this changed system work from the point of view of the reciprocal relationship towards an adult person with a disability (adapted from Košča, 1987)

Diagnosis of adults with mental disabilities also uses clinical and test methods. Their overview is given in current and older psychiatric literature, cf. Valenta, Müller, 2009; Black, 2009; Valenta, Michalík, Lečbych et al., 2012; Hučík et al., 2012; Bartoňová, Bazalová, Pipeková, 2007. Standardized instruments are based on comparing the individual's performance compared to the results of the general population, therefore emphasis should be placed on individualization - i.e. not comparing the individual's performance with peers without disabilities or with norms for a given age group. As stated by many other experts, Valenta, Müller, 2009; Bartoňová, 2007; Lečbych, 2008, the use of diagnostic tools for adults with mental disabilities is very problematic. There are several reasons:

• the necessity of modifying the entry of instructions and obtaining answers (it is appropriate to involve different communication channels),
• specification of time schedule (provide longer time for their preparation or pauses during it),
• external conditions of the testing site,
• application of only selected passages of text.

Only some of the available materials that can serve as evaluation elements for defining the level of individual areas can be selected:

• Observation: from this category, self-observation is applied with difficulty (with regard to the judgment skills of people with mental disabilities).
• Interview: always limits the presence of impaired communication skills, formulation of questions, mutual attunement between participants,
• Anamnesis: enables obtaining information about a person and his problems from different environments, again it is possible to use self-anamnesis, but on the condition that certain conditions are met,
• Questionnaire: assumes knowledge of written speech, it should not be too extensive, questions clear, concise and understandable, non-suggestive items, unknown terms must not be included. Based on knowledge from practice, this form can be well used by adults with a milder type of mental disability.

According to Černá (2008), specific tests whose target group is adults with mental disabilities are thematically focused on the field of choosing a profession:

• Picture test for choosing a profession,
• Picture test of career interests.

In old age, you can use the Senior Software Package (used mainly abroad), evaluates:

• speed of reactions,
• auditory discrimination,
• spatial memory,
• memory for numbers,
• memory for words,
• naming subjects,
• understanding of succession,
• understanding the test (Ibid.).

In the Czech Republic, there are competent school counseling facilities from a diagnostic point of view, which are listed in decree no. 116/2011 Coll., amending Decree no. 72/2005 Coll., on the provision of counseling services in schools and school counseling facilities, specifically Pedagogical-Psychological Counseling Centers and Special Pedagogical Centers. Both of the above-mentioned facilities are very busy, especially with children's clientele, and due to the upper age limit, there is neither time nor disposition to diagnose adults with mental disabilities. This fact appears to be problematic in the case of the necessary diagnosis of the competences of today's adults with mental disabilities, who were deprived of the obligation to attend school in their youth. As stated by e.g. Michalík (2013) was the headmaster of the school. In the next age, no one tried to re-examine the said decision (Křížkovská, 2013). Today, thanks to inclusive trends, they can achieve a more stable participation in the life of society, but the diagnosis itself will also be an obstacle. There is currently no equipment available in the Czech Republic that would work with the diagnostic process for adults with mental disabilities.

People with mental disabilities are most often tested in the field of cognitive functions such as intelligence, memory, thinking, and attention. The result of the identification of these areas is the determination of the intelligence quotient (which is further divided into verbal and non-verbal components). The entire personality structure is expressed only by a number. As stated by Lečbych (2008), adults with mental disabilities cannot be differentiated only on the basis of the measured IQ value. Psychologists most often use children's versions of the Wechsler test, the Stanford-Binet test or the WISC to test intelligence.

Knowledge from the practical part

As part of the research of the Specific Grant Competition conducted at UP Olomouc, a survey was conducted among different groups of respondents. The questions related to the issue of the diagnostic process from the point of view of special educators, psychologists, social workers/persons who work with adults with mental disabilities and family members. Data collection took place for 1 year.

Partial conclusions of the investigation by psychologists and social workers/persons who work with adults with mental disabilities will now be presented. The representation of psychologists in the investigation was 10 people of different ages and different work experience. Social workers/persons who work with adults with mental disabilities also participated in the research in the number of 10 persons, again they were respondents of different age categories and length of experience. Interview was chosen as the data collection method.

Psychologists in the vast majority of respondents stated that during their profession they did not encounter a requirement regarding the diagnosis of adults with mental disabilities. At the same time, they are not aware of the aforementioned target group, they are not sure (or do not know) which direction the diagnostic process should take and what its result should be. From the group of people with different degrees of mental disability, they can better imagine working with people with a mild degree of mental disability, they perceive these people as more accessible to the diagnostic process. They are particularly concerned about finding a suitable method of interpersonal communication, the limitations of which may, to varying degrees, threaten the very process of examining an adult with a mental disability. At the same time, they were not sure of any other alternative to the verbal examination. The psychologists approached are not sure what diagnostic tools they would apply to the target group. However, even if they do not know what methods they should work with, they do not admit that their professional competence is insufficient. Half of the interviewed psychologists do not see the benefit in diagnosing adults with mental disabilities, according to their testimony, they do not see a change in the personality of an individual with a mental disability. Therefore, if the diagnosis of mental retardation has already been established once in life, it does not need to be verified in adulthood.

For comparison, the interpretation of the statements of social workers/persons who work with adults with mental disabilities will now be presented. Compared to the previous group of respondents, it should be added that these participants in the research survey meet adults with mental disabilities in their work activities more often and more regularly than the group of psychologists.

Social workers/persons who work with adults with mental disabilities, on the other hand, emphasized the importance of diagnosing adults with mental disabilities. They see its benefit especially in connection with respecting the maturity of the individual and the predictable/anticipated shift in their personality. They mentioned in particular the absence of any official documents or information that would in a certain way shed light on the past of an adult, i.e. the diagnosis assigned in his early childhood. They state as essential those situations where an adult person with a mental disability lived at birth within an institution, or was in substitute family care for a certain period of time, but there is no knowledge of these situations. Some of them even emphasized the need for re-diagnosis in adults, drawing attention to the fact that during their practice they met adults whose last record is, for example, 15 years old. From their position, this group of respondents was uncertain in terms of enumerating the diagnostic tools that could be applied, they most often gave the answer "test", "interview", "work with interests and wishes". According to their opinion, a psychologist, a special pedagogue, a key worker (that is, the person who most often cooperates with an adult with a mental disability) and the adult with a mental disability should participate in the process of diagnosis in adulthood. But they were unable to list specific tools that could be applied in practice.

They would welcome the introduction of a diagnostic process that would concern the mentioned target group, especially at the time of transition of an adult with a mental disability to another facility (whether due to older age, deterioration of symptoms or, on the contrary, transfer to sheltered or supported housing/employment...). In their opinion, the presence of available documents from a previous life, which can serve as a basis for diagnosis in the current device, would greatly facilitate the acceptance of a new "client". For social workers/persons who work with adults with mental disabilities, information about the level of the measured intelligence quotient is only informative about the level of service they can offer. Another positive fact of the diagnostic process is the verification of legal capacity, which in practice conditions the inclusion of an individual in preparation for work in the protected and open labor market.

Conclusion

The above text represents partial results of the Specific Grant Competition held in 2013 at PdF UP Olomouc. It discusses the issue of the diagnostic process for adults with mental disabilities among selected groups of respondents, namely psychologists, as well as social workers/persons who work with adults with mental disabilities.

Based on a brief overview of the statements, the diversity of the mentioned problem from the point of view of different experts is evident. The statements of both groups of respondents are surprising. Based on them, it would be appropriate to include special pedagogical topics in the undergraduate training of psychologists. As well as supporting education in the area of ​​the diagnostic domain for adults with mental disabilities as an element of a person-centered approach from the point of view of social services. The mentioned area would deserve a wider space for other research strategies.

Author: Mgr. Petra Křížkovská List of used literature 1. BAJO, I.; VAŠEK, Š. Pedagogy of the mentally disabled. Bratislava: Sapientia, 1994. 248 p. ISBN 80-967180-1-0. 2. BARTOŇOVÁ, M.; BAZALOVA, B.; PIPEKOVÁ, J. Psychopedia. Brno: Paido, 2007. 140 p. ISBN 978-80-7315-161-4. 3. CSEFALVAY, Z.; LECHTA, V. Diagnosis of impaired communication skills in adults. Prague: Portal, 2013. 288 p. ISBN 978-80-262-0364-3. 4. ČERNÁ, M. Czech Psychopedia. Prague: Karolinum, 2008. 222 p. ISBN 978-80-246-1565-3. 5. KOŠČO, J. Counseling psychology. Bratislava, 1987. 446 p. 6. KREJČÍŘOVÁ, O.; VYMAZALOVA, E.; HUBLAR, J. Theory and practice of special pedagogical andragogy. Olomouc: UP Olomouc, 2011. 71 p. ISBN 978-80-244-2880-2. 7. KŘÍŽKOVSKÁ, P. Inclusive approaches to adults with mental disabilities. Olomouc: UP Olomouc, 2013. 128 p. ISBN 978-80-244-3375-2. 8. LEČBYCH, M. Mental retardation in adolescence and young adulthood. Olomouc: UP Olomouc. 248 p. ISBN 978-80-244-2071-4. 9. MICHALÍK, J. Law, society and disability. Olomouc: UP Olomouc, 2013. ISBN 978-80-244-3534-3. 10. ŠVARCOVÁ, I. Mental retardation. Prague: Portal, 2006. 198 p. ISBN 80-7367-060-7. 11. VALENTA, M.; MÜLLER, O. Psychopedia. Prague: Parta, 2009. 443 p. ISBN 978-80-7320-039-2. 12. VALENTA, M.; KOZÁKOVÁ, Z. Psychopedia for educational workers. Olomouc: UP Olomouc, 2006. 61 p. ISBN 80-244-1187-3. 13. VAŠEK, Š. Special pedagogical diagnostics. Prague: JAK, 2006. 140 p. ISBN 80-86723-21-6. 14. INTERNATIONAL CLASSIFICATION OF DISEASES. Uzis. [cit. on 01-10-2014] ©2014. Available from WWW: .