Also found in: Dictionary, Thesaurus, Legal, Acronyms, Encyclopedia, Wikipedia. 5 million mentally retarded individuals live in the United States alone. Mental retardation begins in childhood or adolescence before the age of 18. In most cases, mental retardation persists throughout adulthood.
A diagnosis of mental retardation is made if an individual has an intellectual functioning level well below average and significant limitations in two or more adaptive skill areas. In general, mentally retarded children reach developmental milestones such as walking and talking much later than the general population. Symptoms of mental retardation may appear at birth or later in childhood. Time of onset depends on the suspected cause of the disability. Some cases of mild mental retardation are not diagnosed before the child enters preschool. These children typically have difficulties with social, communication, and functional academic skills.
The DSM-IV classifies four different degrees of mental retardation: mild, moderate, severe, and profound. These categories are based on the functioning level of the individual. Their IQ score ranges from 50-75, and they can often acquire academic skills up to the 6th grade level. They can become fairly self-sufficient and in some cases live independently, with community and social support. Moderately retarded individuals have IQ scores ranging from 35-55.
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They can carry out work and self-care tasks with moderate supervision. They typically acquire communication skills in childhood and are able to live and function successfully within the community in a supervised environment such as a group home. Severely retarded individuals have IQ scores of 20-40. They may master very basic self-care skills and some communication skills.
Many severely retarded individuals are able to live in a group home. Profoundly retarded individuals have IQ scores under 20-25. They may be able to develop basic self-care and communication skills with appropriate support and training. Their retardation is often caused by an accompanying neurological disorder. The profoundly retarded need a high level of structure and supervision.
The AAMR classification system focuses on the capabilities of the retarded individual rather than on the limitations. The categories describe the level of support required. They are: intermittent support, limited support, extensive support, and pervasive support. Aggression, self-injury, and mood disorders are sometimes associated with the disability. The severity of the symptoms and the age at which they first appear depend on the cause. Children who are mentally retarded reach developmental milestones significantly later than expected, if at all.
Mental retardation may be caused by an inherited abnormality of the genes, such as fragile X syndrome. Fragile X, a defect in the chromosome that determines sex, is the most common inherited cause of mental retardation. Some studies have shown that even moderate alcohol use during pregnancy may cause learning disabilities in children. Maternal infections and illnesses such as glandular disorders, rubella, toxoplasmosis, and cytomegalovirus infection may cause mental retardation. Birth defects that cause physical deformities of the head, brain, and central nervous system frequently cause mental retardation. Neural tube defect, for example, is a birth defect in which the neural tube that forms the spinal cord does not close completely.
Children who live in poverty and suffer from malnutrition, unhealthy living conditions, and improper or inadequate medical care are at a higher risk. Exposure to lead can also cause mental retardation. Conditions such as hyperthyroidism and PKU are treatable. If these conditions are discovered early, the progression of retardation can be stopped and, in some cases, partially reversed. Children are given intelligence tests to measure their learning abilities and intellectual functioning. Such tests include the Stanford-Binet Intelligence Scale, the Wechsler Intelligence Scales, the Wechsler Preschool and Primary Scale of Intelligence, and the Kaufmann Assessment Battery for Children.
For children under the age of three, many states have established early intervention programs that assess, recommend, and begin treatment programs. Many day schools are available to help train retarded children in basic skills such as bathing and feeding themselves. Training in independent living and job skills is often begun in early adulthood. The level of training depends on the degree of retardation. Mildly retarded individuals can often acquire the skills needed to live independently and hold an outside job. Moderate to profoundly retarded individuals usually require supervised community living. Family therapy can help relatives of the mentally retarded develop coping skills.
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It can also help parents deal with feelings of guilt or anger. A supportive, warm home environment is essential to help the mentally retarded reach their full potential. To reach these goals, they need appropriate and consistent educational, community, social, family, and vocational supports. The outlook is less promising for those with severe to profound retardation. Studies have shown that these individuals have a shortened life expectancy.
In addition, all children should undergo routine developmental screening as part of their pediatric care. Screening is particularly critical for those children who may be neglected or undernourished or may live in disease-producing conditions. Good prenatal care can also help prevent retardation. Pregnant women should be educated about the risks of drinking and the need to maintain good nutrition during pregnancy. Tests such as amniocentesis and ultrasonography can determine whether a fetus is developing normally in the womb. 900 Varnum Street NE, Washington, D.
Laboratory analysis of this fluid can detect various genetic defects, such as Down syndrome, or neural tube defects. Developmental delay — The failure to meet certain developmental milestones, such as sitting, walking, and talking, at the average age. Developmental delay may indicate a problem in development of the central nervous system. Down syndrome — A disorder caused by an abnormality at the 21st chromosome. One symptom of Down syndrome is mental retardation. Extensive support — Ongoing daily support required to assist an individual in a specific adaptive area, such as daily help with preparing meals. This disease mainly affects children under the age of five.
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In that age group, it is the leading cause of bacterial meningitis, pneumonia, joint and bone infections, and throat inflammations. Inborn errors of metabolism can cause brain damage and mental retardation if left untreated. Phenylketonuria is an inborn error of metabolism. Limited support — A predetermined period of assistance required to deal with a specific event, such as training for a new job. An inborn error in metabolism that prevents the body from using phenylalanine, an amino acid necessary for normal growth and development. Trisomy — An abnormality in chromosomal development.
Chromosomes are the structures within a cell that carry its genetic information. Humans have 23 pairs of chromosomes. In a trisomy syndrome, an extra chromosome is present so that the individual has three of a particular chromosome instead of the normal pair. Ultrasonography — A process that uses the reflection of high-frequency sound waves to make an image of structures deep within the body. Ultrasonography is routinely used to detect fetal abnormalities. Mental disorders are assumed to result from some behavioral, psychological, or biological dysfunction in the individual. Mental retardation is a relative term.
Its meaning depends on what society demands of the individual in learning, skills, and social responsibility. Many people who are considered developmentally challenged in the complex modern world would get along normally in a simpler society. Diagnosis: There is no absolute measurement for retardation. At one time the different types were classified only according to the apparent severity of the retardation.
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The average person is considered to have an IQ of between 90 and 110, and those who score below 70 are considered mentally retarded. In the past, the different groupings were classified in terms such as feebleminded, idiot, imbecile, and moron. Whatever classifications are used, it is agreed that IQ measurements are only one part of the factors to be considered in determining mental retardation. About 85 per cent of patients considered mentally retarded are in the least severe, or mild, group. Those in this group do not usually have obvious physical defects and thus are not always easy to identify as mentally retarded while they are still infants.
Sometimes such a child’s mental defects do not show up until the time of entering school, when the child has difficulty learning and keeping up with others in the same age group. Acquired conditions may be prenatal, perinatal, or postnatal. Perinatal causes are anoxia, birth injury, and prematurity. Postnatal causes may include infections, poisons, poor nutrition, trauma, and sociocultural factors such as deprivation. Many conditions that can cause severe retardation can be diagnosed during pregnancy, and in some cases proper treatment can lessen or even prevent retardation.
Proper care for the mother during pregnancy and for the baby in the first months of life is also important. The cause may be genetic, biological, psychosocial, or traumatic. Subaverage general intellectual functioning that originates during the developmental period and is associated with impairment in adaptive behavior. In general, an IQ of 70 or lower indicates mental retardation.
Intellectual ability so much below average as to preclude the performance of most forms of work or other social functions. Mentally retarded people usually require supervision and guidance if they are to avoid distress or danger. There are degrees of mental deficiency. Subaverage general intellectual functioning starting with developmental period, associated with impairment in adaptive behavior.
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Children with intellectual disabilities or other developmental conditions can compete in the Special Olympics. Once focused almost entirely on cognition, the definition now includes both a component relating to mental functioning and one relating to individuals’ functional skills in their environments. As a result of this focus on the person’s abilities in practice, a person with an unusually low IQ may not be considered to have intellectually disability. Intellectual disability is subdivided into syndromic intellectual disability, in which intellectual deficits associated with other medical and behavioral signs and symptoms are present, and non-syndromic intellectual disability, in which intellectual deficits appear without other abnormalities. Seventy-five to ninety percent of the affected people have mild intellectual disability. The level of impairment ranges in severity for each person. Speech delays are particularly common signs of moderate ID.
People with moderate intellectual disability need considerable supports in school, at home, and in the community in order to fully participate. While their academic potential is limited, they can learn simple health and safety skills and to participate in simple activities. People with severe or profound ID need more intensive support and supervision their entire lives. They may learn some ADLs, but an intellectual disability is considered severe or profound when individuals are unable to independently care for themselves without ongoing significant assistance from a caregiver throughout adulthood.
Down syndrome is the most common genetic cause of intellectual disability. Among children, the cause of intellectual disability is unknown for one-third to one-half of cases. Genetic defects that cause intellectual disability but are not inherited can be caused by accidents or mutations in genetic development. Sometimes disability is caused by abnormal genes inherited from parents, errors when genes combine, or other reasons. Intellectual disability can result when the fetus does not develop properly.
For example, there may be a problem with the way the fetus’ cells divide as it grows. 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. Exposure to certain types of disease or toxins. Iodine deficiency, affecting approximately 2 billion people worldwide, is the leading preventable cause of intellectual disability in areas of the developing world where iodine deficiency is endemic. Malnutrition is a common cause of reduced intelligence in parts of the world affected by famine, such as Ethiopia.
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It is formally diagnosed by an assessment of IQ and adaptive behavior. A third condition requiring onset during the developmental period is used to distinguish intellectual disability from other conditions dementia such as Alzheimer’s disease or traumatic brain injuries. Binet Intelligence Scales, was adapted from a test battery designed for school placement by Alfred Binet in France. Since current diagnosis of intellectual disability is not based on IQ scores alone, but must also take into consideration a person’s adaptive functioning, the diagnosis is not made rigidly. 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 persons’ functioning in the community from people who know them well. By most definitions, intellectual disability is more accurately considered a disability rather than a disease. Intellectual disability can be distinguished in many ways from mental illness, such as schizophrenia or depression. There are thousands of agencies around the world that provide assistance for people with developmental disabilities. They include state-run, for-profit, and non-profit, privately run agencies. 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. These include psychosocial treatments, behavioral treatments, cognitive-behavioral treatments, and family-oriented strategies. Core components of behavioral treatments include language and social skills acquisition. Typically, one-to-one training is offered in which a therapist uses a shaping procedure in combination with positive reinforcements to help the child pronounce syllables until words are completed.
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Although there is no specific medication for intellectual disability, many people with developmental disabilities have further medical complications and may be prescribed several medications. For example, autistic children with developmental delay may be prescribed antipsychotics or mood stabilizers to help with their behavior. About a quarter of cases are caused by a genetic disorder. Intellectual disability has been documented under a variety of names throughout history.
Throughout much of human history, society was unkind to those with any type of disability, and people with intellectual disability were commonly viewed as burdens on their families. Greek and Roman philosophers, who valued reasoning abilities, disparaged people with intellectual disability as barely human. Negative stereotypes were prominent in social attitudes of the time. In the 13th century, England declared people with intellectual disability to be incapable of making decisions or managing their affairs.
Guardianships were created to take over their financial affairs. In the 17th century, Thomas Willis provided the first description of intellectual disability as a disease. He believed that it was caused by structural problems in the brain. According to Willis, the anatomical problems could be either an inborn condition or acquired later in life.
In the 18th and 19th centuries, housing and care moved away from families and towards an asylum model. In the late 19th century, in response to Charles Darwin’s On the Origin of Species, Francis Galton proposed selective breeding of humans to reduce intellectual disability. In 1905, Alfred Binet produced the first standardized test for measuring intelligence in children. Although ancient Roman law had declared people with intellectual disability to be incapable of the deliberate intent to harm that was necessary for a person to commit a crime, during the 1920s, Western society believed they were morally degenerate. Ignoring the prevailing attitude, Civitans adopted service to people with developmental disabilities as a major organizational emphasis in 1952.
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Their earliest efforts included workshops for special education teachers and daycamps for children with disabilities, all at a time when such training and programs were almost nonexistent. The publication of this book may be regarded as the first move towards the widespread adoption of the social model of disability in regard to these types of disabilities, and was the impetus for the development of government strategies for desegregation. From the 1960s to the present, most states have moved towards the elimination of segregated institutions. By the mid-1970s, most governments had committed to de-institutionalization, and had started preparing for the wholesale movement of people into the general community, in line with the principles of normalization. In the past, lead poisoning and infectious diseases were significant causes of intellectual disability.
Some causes of intellectual disability are decreasing, as medical advances, such as vaccination, increase. Along with the changes in terminology, and the downward drift in acceptability of the old terms, institutions of all kinds have had to repeatedly change their names. This affects the names of schools, hospitals, societies, government departments, and academic journals. For example, the Midlands Institute of Mental Subnormality became the British Institute of Mental Handicap and is now the British Institute of Learning Disability.