| Disorders usually first diagnosed in infancy, childhood, or adolescence. |
Mental Retardation--
Mental retardation is a term for a pattern of persistently slow learning of basic motor and language
skills ("milestones") during childhood, and a significantly below-normal global intellectual capacity as
an adult. One common criterion for diagnosis of mental retardation is a tested intelligence quotient
(IQ) of 70 or below and deficits in adaptive functioning.
People with mental retardation may be described as having developmental disabilities, global
developmental delay, or learning difficulties.
Alternative terms
The term "Mental retardation" has acquired pejorative and shameful connotations over the last few
decades and is now used almost exclusively in technical or scientific contexts.
* In North America the broad term developmental delay has become an increasingly preferred
synonym by many parents and direct support professionals. Elsewhere, however, developmental
delay is generally used to imply that appropriate intervention will improve or completely eliminate the
condition, allowing for "catching up." Importantly, this term carries the emotionally powerful idea that
the individual's current difficulties are likely to be temporary.
* Developmental disability is preferred by most physicians, but can also refer to any other physical or
psychiatric delay, such as delayed puberty.
* The phrase intellectual disability is increasingly being used as a synonym for people with
significantly below-average IQ.[1] These terms are sometimes used as a means of separating general
intellectual limitations from specific, limited deficits as well as indicating that it is not an emotional or
psychological disability. Intellectual disability is also used to describe the outcome of traumatic brain
injury or lead poisoning or dementing conditions such as Alzheimer's disease. It is not specific to
congenital conditions like Down syndrome.
The American Association on Mental Retardation continued to use the term mental retardation until
2006.[2] In June 2006 its members voted to change the name of the organisation to the "American
Association on Intellectual and Developmental Disabilities," rejecting the options to become the AAID
or AADD. Part of the rationale for the double name was that many of the members worked with
people with autism and Asperger syndrome, also known as pervasive developmental disorders, not
all of whom were also mentally retarded.
In the UK, "mental handicap" had become the common medical term, replacing "mental subnormality"
in Scotland and "mental deficiency" in England and Wales, until Stephen Dorrell, Secretary of State
for Health in England and Wales from 1995-7, changed the National Health Service's designation to
"learning disability." The new term is not yet widely understood, and is often taken to refer to
problems affecting schoolwork (the American usage): which are known in the UK as "learning
difficulties." British social workers may use "learning difficulty" to refer to both people with MR and
those with conditions such as dyslexia.
In England and Wales the Mental Health Act 1983 defines "mental impairment" and "severe mental
impairment" as "a state of arrested or incomplete development of mind which includes significant and
severe impairment of intelligence and social functioning and is associated with abnormally aggressive
or seriously irresponsible conduct on the part of the person concerned."[3] As behavior is involved,
these are not necessarily permanent conditions: they are defined for the purpose of authorising
detention in hospital or guardianship. However, English statute law uses "mental impairment"
elsewhere in a less well-defined manner—e.g. to allow exemption from taxes—implying that mental
retardation without any behavioural problems is what is meant. Mental Impairment is scheduled to be
removed from the Act when it is amended in 2008.
Signs
There are many signs. For example, children with developmental disabilities may learn to sit up, to
crawl, or to walk later than other children, or they may learn to talk later. Both adults and children
with intellectual disabilities may also
* have trouble speaking
* find it hard to remember things
* have trouble understanding social rules
* have trouble discerning cause and effect
* have trouble solving problems
* have trouble thinking logically.
In early childhood mild disability (IQ 60–70) may not be obvious, and may not be diagnosed until
children begin school. Even when poor academic performance is recognized, it may take expert
assessment to distinguish mild mental disability from learning disability or behavior problems. As
they become adults, many people can live independently and may be considered by others in their
community as "slow" rather than retarded.
Moderate disability (IQ 50–60) is nearly always obvious within the first years of life. These people will
encounter difficulty in school, at home, and in the community. In many cases they will need to join
special, usually separate, classes in school, but they can still progress to become functioning
members of society. As adults they may live with their parents, in a supportive group home, or even
semi-independently with significant supportive services to help them, for example, manage their
finances.
Among people with intellectual disabilities, only about one in eight will score below 50 on IQ tests. A
person with a more severe disability will need more intensive support and supervision his or her
entire life.
The limitations of cognitive function will cause a child to learn and develop more slowly than a typical
child. Children may take longer to learn to speak, walk, and take care of their personal needs such as
dressing or eating. Learning will take them longer, require more repetition, and there may be some
things they cannot learn. The extent of the limits of learning is a function of the severity of the
disability.
Nevertheless, virtually every child is able to learn, develop, and grow to some extent.
Diagnosis
According to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV),
[4] there are three criteria before a person is considered to have a developmental disability: an IQ
below 70, significant limitations in two or more areas of adaptive behavior (i.e., ability to function at
age level in an ordinary environment), and evidence that the limitations became apparent in childhood.
It is formally diagnosed by professional assessment of intelligence and adaptive behavior.
IQ below 70
IQ tests were created as an attempt to measure a person's abilities in several areas, including
language, numeracy and problem-solving. The average score is 100. People with a score below 75
will often, but not always, have difficulties with daily living skills. Since factors other than mental
ability (depression, anxiety, lack of adequate effort, cultural differences, etc.) can yield low IQ scores,
it is important for the evaluator to rule them out prior to concluding that measured IQ is
"significantly below average".
The following ranges, based on the Wechsler Adult Intelligence Scale (WAIS), are in standard use
today:
Class IQ
Profound mental retardation Below 20
Severe mental retardation 20–34
Moderate mental retardation 35–49
Mild mental retardation 50–69
Borderline mental retardation 70–79
Significant limitations in two or more areas of adaptive behavior
Adaptive behavior, or adaptive functioning, refers to the skills needed to live independently (or at the
minimally acceptable level for age). To assess adaptive behavior, professionals compare the
functional abilities of a child to those of other children of similar age. To measure adaptive behavior,
professionals use structured interviews, with which they systematically elicit information about the
person's functioning in the community from someone who knows them well. There are many
adaptive behavior scales, and accurate assessment of the quality of someone's adaptive behavior
requires clinical judgment as well. Certain skills are important to adaptive behavior, such as:
* daily living skills, such as getting dressed, using the bathroom, and feeding oneself;
* communication skills, such as understanding what is said and being able to answer;
* social skills with peers, family members, spouses, adults, and others.
Evidence that the limitations became apparent in childhood
This third condition is used to distinguish it from dementing conditions such as Alzheimer's disease
or is due to traumatic injuries that damaged the brain.
Causes
Down syndrome, fetal alcohol syndrome and Fragile X syndrome are the three most common inborn
causes. However, doctors have found many other causes. The most common are:
* Genetic conditions. Sometimes disability is caused by abnormal genes inherited from parents,
errors when genes combine, or other reasons. Examples of genetic conditions include Down
syndrome, Fragile X syndrome, Phelan-McDermid syndrome (22q13del), Mowat-Wilson syndrome
and phenylketonuria (PKU).
* Problems during pregnancy. Mental disability can result when the fetus does not develop inside the
mother properly. For example, there may be a problem with the way the fetus's cells divide as it
grows. A woman who drinks alcohol (see fetal alcohol syndrome) or gets an infection like rubella
during pregnancy may also have a baby with mental disability.
* Problems at birth. If a baby has problems during labor and birth, such as not getting enough
oxygen, he or she may have developmental disability due to brain damage.
* Health problems. Diseases like whooping cough, measles, or meningitis can cause mental disability.
It can also be caused by not getting enough medical care, or by being exposed to poisons like lead
or mercury.
* Iodine deficiency, affecting approximately 2 billion people worldwide, is the leading preventable
cause of mental disability in areas of the developing world where iodine deficiency is endemic. Iodine
deficiency also causes goiter, an enlargement of the thyroid gland. More common than full-fledged
cretinism, as retardation caused by severe iodine deficiency is called, is mild impairment of
intelligence. Certain areas of the world due to natural deficiency and governmental inaction are
severely affected. India is the most outstanding, with 500 million suffering from deficiency, 54 million
from goiter, and 2 million from cretinism. Among other nations affected by iodine deficiency, China
and Kazakhstan have begun taking action, while Russia has not. [5]
* Malnutrition is a common cause of reduced intelligence in parts of the world affected by famine,
such as Ethiopia. [6]
* The use of forceps during birth can lead to mental retardation in an otherwise normal child. They
can fracture the skull and cause brain damage.
* Institutionalisation at a young age can cause mental retardation in normal children.
* Sensory deprivation in the form of severe environmental restrictions (such as being locked in a
basement or under a staircase), prolonged isolation, or severe atypical parent-child interactions.
* Psycho-social disadvantage. Contributing factors are lack of reading material, use of a language
not common in that community, poor diet, poor health practices, and poor housing.
Treatment and assistance
By most definitions mental retardation is more accurately considered a disability rather than a
disease. MR can be distinguished in many ways from mental illness, such as schizophrenia or
depression. Currently, there is no "cure" for an established disability, though with appropriate
support and teaching, most individuals can learn to do many things.
There are thousands of agencies in the United States that provide assistance for people with
developmental disabilities. They include state-run, for-profit, and non-profit, privately run agencies.
Within one agency there could be departments that include fully staffed residential homes, day
habilitation programs that approximate schools, workshops wherein people with disabilities can
obtain jobs, programs that assist people with developmental disabilities in obtaining jobs in the
community, programs that provide support for people with developmental disabilities who have their
own apartments, programs that assist them with raising their children, and many more. The Burton
Blatt Institute at Syracuse University works to advance the civic, economic, and social participation of
people with disabilities. There are also many agencies and programs for parents of children with
developmental disabilities.
Although there is no specific medication for "mental retardation", many people with developmental
disabilities have further medical complications and may take several medications. Beyond that there
are specific programs that people with developmental disabilities can take part in wherein they learn
basic life skills. These "goals" may take a much longer amount of time for them to accomplish, but
the ultimate goal is independence. This may be anything from independence in tooth brushing to an
independent residence. People with developmental disabilities learn throughout their lives and can
obtain many new skills even late in life with the help of their families, caregivers, clinicians and the
people who coordinate the efforts of all of these people.
References
1. ^ MENCAP: Website of the UK's leading learning disability charity. Retrieved 28 June 2006
2. ^ AAIDD POSITION STATEMENTS. Retrieved on 2007-08-23.
3. ^ DRAFT ILLUSTRATIVE CODE OF PRACTICE. Retrieved on 2007-08-23.
4. ^ eMedicine - Mental Retardation : Article by C Simon Sebastian, MD. Retrieved on 2007-08-23.
5. ^ "In Raising the World’s I.Q., the Secret’s in the Salt", article by Donald G. McNeil, Jr., December
16, 2006, New York Times
6. ^ "Malnutrition Is Cheating Its Survivors, and Africa’s Future" article in the New York Times by
Michael Wines, December 28, 2006
7. ^ BBC (2003). Worst Word Vote (HTML). Ouch. Retrieved on 2007-08-17.
Mental retardation is a term for a pattern of persistently slow learning of basic motor and language
skills ("milestones") during childhood, and a significantly below-normal global intellectual capacity as
an adult. One common criterion for diagnosis of mental retardation is a tested intelligence quotient
(IQ) of 70 or below and deficits in adaptive functioning.
People with mental retardation may be described as having developmental disabilities, global
developmental delay, or learning difficulties.
Alternative terms
The term "Mental retardation" has acquired pejorative and shameful connotations over the last few
decades and is now used almost exclusively in technical or scientific contexts.
* In North America the broad term developmental delay has become an increasingly preferred
synonym by many parents and direct support professionals. Elsewhere, however, developmental
delay is generally used to imply that appropriate intervention will improve or completely eliminate the
condition, allowing for "catching up." Importantly, this term carries the emotionally powerful idea that
the individual's current difficulties are likely to be temporary.
* Developmental disability is preferred by most physicians, but can also refer to any other physical or
psychiatric delay, such as delayed puberty.
* The phrase intellectual disability is increasingly being used as a synonym for people with
significantly below-average IQ.[1] These terms are sometimes used as a means of separating general
intellectual limitations from specific, limited deficits as well as indicating that it is not an emotional or
psychological disability. Intellectual disability is also used to describe the outcome of traumatic brain
injury or lead poisoning or dementing conditions such as Alzheimer's disease. It is not specific to
congenital conditions like Down syndrome.
The American Association on Mental Retardation continued to use the term mental retardation until
2006.[2] In June 2006 its members voted to change the name of the organisation to the "American
Association on Intellectual and Developmental Disabilities," rejecting the options to become the AAID
or AADD. Part of the rationale for the double name was that many of the members worked with
people with autism and Asperger syndrome, also known as pervasive developmental disorders, not
all of whom were also mentally retarded.
In the UK, "mental handicap" had become the common medical term, replacing "mental subnormality"
in Scotland and "mental deficiency" in England and Wales, until Stephen Dorrell, Secretary of State
for Health in England and Wales from 1995-7, changed the National Health Service's designation to
"learning disability." The new term is not yet widely understood, and is often taken to refer to
problems affecting schoolwork (the American usage): which are known in the UK as "learning
difficulties." British social workers may use "learning difficulty" to refer to both people with MR and
those with conditions such as dyslexia.
In England and Wales the Mental Health Act 1983 defines "mental impairment" and "severe mental
impairment" as "a state of arrested or incomplete development of mind which includes significant and
severe impairment of intelligence and social functioning and is associated with abnormally aggressive
or seriously irresponsible conduct on the part of the person concerned."[3] As behavior is involved,
these are not necessarily permanent conditions: they are defined for the purpose of authorising
detention in hospital or guardianship. However, English statute law uses "mental impairment"
elsewhere in a less well-defined manner—e.g. to allow exemption from taxes—implying that mental
retardation without any behavioural problems is what is meant. Mental Impairment is scheduled to be
removed from the Act when it is amended in 2008.
Signs
There are many signs. For example, children with developmental disabilities may learn to sit up, to
crawl, or to walk later than other children, or they may learn to talk later. Both adults and children
with intellectual disabilities may also
* have trouble speaking
* find it hard to remember things
* have trouble understanding social rules
* have trouble discerning cause and effect
* have trouble solving problems
* have trouble thinking logically.
In early childhood mild disability (IQ 60–70) may not be obvious, and may not be diagnosed until
children begin school. Even when poor academic performance is recognized, it may take expert
assessment to distinguish mild mental disability from learning disability or behavior problems. As
they become adults, many people can live independently and may be considered by others in their
community as "slow" rather than retarded.
Moderate disability (IQ 50–60) is nearly always obvious within the first years of life. These people will
encounter difficulty in school, at home, and in the community. In many cases they will need to join
special, usually separate, classes in school, but they can still progress to become functioning
members of society. As adults they may live with their parents, in a supportive group home, or even
semi-independently with significant supportive services to help them, for example, manage their
finances.
Among people with intellectual disabilities, only about one in eight will score below 50 on IQ tests. A
person with a more severe disability will need more intensive support and supervision his or her
entire life.
The limitations of cognitive function will cause a child to learn and develop more slowly than a typical
child. Children may take longer to learn to speak, walk, and take care of their personal needs such as
dressing or eating. Learning will take them longer, require more repetition, and there may be some
things they cannot learn. The extent of the limits of learning is a function of the severity of the
disability.
Nevertheless, virtually every child is able to learn, develop, and grow to some extent.
Diagnosis
According to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV),
[4] there are three criteria before a person is considered to have a developmental disability: an IQ
below 70, significant limitations in two or more areas of adaptive behavior (i.e., ability to function at
age level in an ordinary environment), and evidence that the limitations became apparent in childhood.
It is formally diagnosed by professional assessment of intelligence and adaptive behavior.
IQ below 70
IQ tests were created as an attempt to measure a person's abilities in several areas, including
language, numeracy and problem-solving. The average score is 100. People with a score below 75
will often, but not always, have difficulties with daily living skills. Since factors other than mental
ability (depression, anxiety, lack of adequate effort, cultural differences, etc.) can yield low IQ scores,
it is important for the evaluator to rule them out prior to concluding that measured IQ is
"significantly below average".
The following ranges, based on the Wechsler Adult Intelligence Scale (WAIS), are in standard use
today:
Class IQ
Profound mental retardation Below 20
Severe mental retardation 20–34
Moderate mental retardation 35–49
Mild mental retardation 50–69
Borderline mental retardation 70–79
Significant limitations in two or more areas of adaptive behavior
Adaptive behavior, or adaptive functioning, refers to the skills needed to live independently (or at the
minimally acceptable level for age). To assess adaptive behavior, professionals compare the
functional abilities of a child to those of other children of similar age. To measure adaptive behavior,
professionals use structured interviews, with which they systematically elicit information about the
person's functioning in the community from someone who knows them well. There are many
adaptive behavior scales, and accurate assessment of the quality of someone's adaptive behavior
requires clinical judgment as well. Certain skills are important to adaptive behavior, such as:
* daily living skills, such as getting dressed, using the bathroom, and feeding oneself;
* communication skills, such as understanding what is said and being able to answer;
* social skills with peers, family members, spouses, adults, and others.
Evidence that the limitations became apparent in childhood
This third condition is used to distinguish it from dementing conditions such as Alzheimer's disease
or is due to traumatic injuries that damaged the brain.
Causes
Down syndrome, fetal alcohol syndrome and Fragile X syndrome are the three most common inborn
causes. However, doctors have found many other causes. The most common are:
* Genetic conditions. Sometimes disability is caused by abnormal genes inherited from parents,
errors when genes combine, or other reasons. Examples of genetic conditions include Down
syndrome, Fragile X syndrome, Phelan-McDermid syndrome (22q13del), Mowat-Wilson syndrome
and phenylketonuria (PKU).
* Problems during pregnancy. Mental disability can result when the fetus does not develop inside the
mother properly. For example, there may be a problem with the way the fetus's cells divide as it
grows. A woman who drinks alcohol (see fetal alcohol syndrome) or gets an infection like rubella
during pregnancy may also have a baby with mental disability.
* Problems at birth. If a baby has problems during labor and birth, such as not getting enough
oxygen, he or she may have developmental disability due to brain damage.
* Health problems. Diseases like whooping cough, measles, or meningitis can cause mental disability.
It can also be caused by not getting enough medical care, or by being exposed to poisons like lead
or mercury.
* Iodine deficiency, affecting approximately 2 billion people worldwide, is the leading preventable
cause of mental disability in areas of the developing world where iodine deficiency is endemic. Iodine
deficiency also causes goiter, an enlargement of the thyroid gland. More common than full-fledged
cretinism, as retardation caused by severe iodine deficiency is called, is mild impairment of
intelligence. Certain areas of the world due to natural deficiency and governmental inaction are
severely affected. India is the most outstanding, with 500 million suffering from deficiency, 54 million
from goiter, and 2 million from cretinism. Among other nations affected by iodine deficiency, China
and Kazakhstan have begun taking action, while Russia has not. [5]
* Malnutrition is a common cause of reduced intelligence in parts of the world affected by famine,
such as Ethiopia. [6]
* The use of forceps during birth can lead to mental retardation in an otherwise normal child. They
can fracture the skull and cause brain damage.
* Institutionalisation at a young age can cause mental retardation in normal children.
* Sensory deprivation in the form of severe environmental restrictions (such as being locked in a
basement or under a staircase), prolonged isolation, or severe atypical parent-child interactions.
* Psycho-social disadvantage. Contributing factors are lack of reading material, use of a language
not common in that community, poor diet, poor health practices, and poor housing.
Treatment and assistance
By most definitions mental retardation is more accurately considered a disability rather than a
disease. MR can be distinguished in many ways from mental illness, such as schizophrenia or
depression. Currently, there is no "cure" for an established disability, though with appropriate
support and teaching, most individuals can learn to do many things.
There are thousands of agencies in the United States that provide assistance for people with
developmental disabilities. They include state-run, for-profit, and non-profit, privately run agencies.
Within one agency there could be departments that include fully staffed residential homes, day
habilitation programs that approximate schools, workshops wherein people with disabilities can
obtain jobs, programs that assist people with developmental disabilities in obtaining jobs in the
community, programs that provide support for people with developmental disabilities who have their
own apartments, programs that assist them with raising their children, and many more. The Burton
Blatt Institute at Syracuse University works to advance the civic, economic, and social participation of
people with disabilities. There are also many agencies and programs for parents of children with
developmental disabilities.
Although there is no specific medication for "mental retardation", many people with developmental
disabilities have further medical complications and may take several medications. Beyond that there
are specific programs that people with developmental disabilities can take part in wherein they learn
basic life skills. These "goals" may take a much longer amount of time for them to accomplish, but
the ultimate goal is independence. This may be anything from independence in tooth brushing to an
independent residence. People with developmental disabilities learn throughout their lives and can
obtain many new skills even late in life with the help of their families, caregivers, clinicians and the
people who coordinate the efforts of all of these people.
References
1. ^ MENCAP: Website of the UK's leading learning disability charity. Retrieved 28 June 2006
2. ^ AAIDD POSITION STATEMENTS. Retrieved on 2007-08-23.
3. ^ DRAFT ILLUSTRATIVE CODE OF PRACTICE. Retrieved on 2007-08-23.
4. ^ eMedicine - Mental Retardation : Article by C Simon Sebastian, MD. Retrieved on 2007-08-23.
5. ^ "In Raising the World’s I.Q., the Secret’s in the Salt", article by Donald G. McNeil, Jr., December
16, 2006, New York Times
6. ^ "Malnutrition Is Cheating Its Survivors, and Africa’s Future" article in the New York Times by
Michael Wines, December 28, 2006
7. ^ BBC (2003). Worst Word Vote (HTML). Ouch. Retrieved on 2007-08-17.
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