Mr. Murray, I spent five years evaluating ICF/MR's for a state agency. During this time I had the good fortune of getting to know many of our mentally retarded citizens. I one to one interviewed hundreds of profoundly MR diagnosed individuals during that time. One thing I found to be consistently true of the MR population is they are more like us than dislike us. Accordingly, may I suggest that you look at variables that effect the normal population of a similar age, race, ethnic background individual etc. Also, look at aspects that may be impacting her present behavior such as: socialization, education(cronological), development (relative). Finally, do not overlook the possibility that she may be having problems that are phsiological or biological in nature. Anxiety may be her only method of communicating with you. I strongly suggest a thorough full spectrum physical examination. After ruling out for medical intervention proceed toward the aforementioned. Finally, I would recommend that you consult with her family to see if there has been changes in composition (ie. birth, deaths, illnesses etc). It has never failed to amaze me as to the degree of sensitivity the MR population has in this area........Good Luck......Ed