Although there has been a continuing development of treatment approaches with applicability in rehabilitation for people with MRPD, it seems likely that a combination of evolving treatment practices and evolving social perspectives in the broad field of developmental disabilities have led to a tendency to underidentify and consequently to undertreat PD among people with MR as a whole (Jacobson & Mulick, 1992, 1994; Jacobson, Mulick, & Schwartz, 1995).
However, it is also likely that, because of de-emphasis of the impact of individual skills on successful adjustment, people with MRPD generally receive unnecessarily and insufficiently specific preparatory and continuing treatment to enhance their social and vocational adjustment, and consequently many vocational settings achieve substantially less favorable social and vocational outcomes for these people than is possible.
A recent meta-analysis of the extent to which the particular anti-labeling bias termed diagnostic overshadowing affects identification rates of MRPD suggests that its impact is small to moderate overall and arguably small for appropriately trained and experienced clinical professionals (White, et al., 1995).
260) for people with MRPD. These factors can be efficiently assessed primarily through individualized and standardized psychometric methods, and will typically lie outside the scope of functional assessment responsibilities that typify professional rehabilitation practice, necessitating referral to specialists.
For the rehabilitation practitioner working with people with MRPD, assessment of psychosocial assets and deficits will require a broad focus on motivation to complete training and ability to work independently, coping with work-based psychosocial and task completion stressors, and social skills required to work collaboratively with others, accept supervision, supervise others, and work with the public (Rubin & Roessler, 1979).
Unfortunately, the literature on MRPD is silent on whether therapist monitoring of treatment effects is typical, but experience suggests that when it does occur, it is cursory and incomplete in nature.
As noted previously, in some instances (e.g., Gardner, et al., in press) clinician researchers have set forth assessment and treatment frameworks grounded in behavior therapeutic models for people with MRPD. More commonly, however, in program descriptions the foundation for adjustment services is not well explicated or entails a mainstream mental health services approach blending psychopharmacological and verbal or cognitive behavior therapy components to address primarily emotional and cognitive factors.
For example, if a person with MRPD can identify opportunities for social reinforcement and structure the environment to advantage, can self-monitor behavior, and can regulate one's own behavior by attending to more distant consequences and learning when social contingencies change (Follette, Bach, & Follette, 1993) then that person can more effectively develop and use social skills in a vocational context.
Although this growth involves trends toward increasing engagement of people with PD and people with MRPD in supported work, there are substantial proportions of managers, counselors, teachers, parents, coworkers, and policy makers who question whether supported work has evident value for people who have severe or profound MR (Black & Meyer, 1992).
However, for most people with MRPD, lifestyle enhancement requires that psychosocial and social skills deficits that are not present for other people with MR be addressed for one crucial reason: disorganized and socially disruptive behavior is poorly tolerated by coworkers and supervisors in work environments, particularly if consistent and reliable performance is important, as it is in most work.