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Mental retardation
Mental retardation
Classification and external resources ICD-10 ICD-9 DiseasesDB F70 317 [1] [3] -F79 [2] [4]
-319
4509
[5]
MedlinePlus 001523 [6] eMedicine MeSH med/3095 D008607 [7] neuro/605 [8]
[9]
Mental retardation (MR) or general learning disability[10] is a generalized disorder appearing before adulthood, characterized by significantly impaired cognitive functioning and deficits in two or more adaptive behaviors. It has historically been defined as an Intelligence Quotient score under 70. 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 environment. As a result, a person with a below-average intelligence quotient may not be considered mentally retarded. Syndromic mental retardation is intellectual deficits associated with other medical and behavioral signs and symptoms. Non-syndromic mental retardation refers to intellectual deficits that appear without other abnormalities. The terms used for this condition are subject to a process called the euphemism treadmill. This means that whatever term is chosen for this condition, it eventually becomes perceived as an insult. The terms mental retardation and mentally retarded were invented in the middle of the 20th century to replace the previous set of terms, which were deemed to have become offensive. By the end of the 20th century, these terms themselves have come to be widely seen as disparaging and politically incorrect and in need of replacement.[] The term intellectual disability or intellectually challenged is now preferred by most advocates in most English-speaking countries. The AAIDD have defined intellectual disability to mean the same thing as mental retardation.[11] Currently, the term mental retardation is used by the World Health Organization in the ICD-10 codes, which has a section titled "Mental Retardation" (codes F70F79). In the future, the ICD-11 is expected to replace the term mental retardation with intellectual disability, and the DSM-5 is expected to replace it with intellectual developmental disorder.[12][13] Because of its specificity and lack of confusion with other conditions, mental retardation is still sometimes used in professional medical settings around the world, such as formal scientific research and health insurance paperwork.[14]
Mental retardation
Children with mental retardation learn more slowly than a typical child. Children may take longer to learn language, develop social skills, and take care of their personal needs, such as dressing or eating. Learning will take them longer, require more repetition, and skills may need to be adapted to their learning level. Nevertheless, virtually every child is able to learn, develop and become a participating member of the community. In early childhood, mild mental retardation (IQ 5069, a cognitive ability about half to two-thirds of standard) may not be obvious, and may not be identified until children begin school.[] Even when poor academic performance is recognized, it may take expert assessment to distinguish mild mental retardation from learning disability or emotional/behavioral disorders. People with mild MR are capable of learning reading and mathematics skills to approximately the level of a typical child aged 9 to 12.[] They can learn self-care and practical skills, such as cooking or using the local mass transit system.[] As individuals with mild mental retardation reach adulthood, many learn to live independently and maintain gainful employment. Moderate mental retardation (IQ 3549) is nearly always apparent within the first years of life. Speech delays are particularly common signs of moderate MR.[] People with moderate mental retardation need considerable supports in school, at home, and in the community in order to participate fully. While their academic potential is limited, they can learn simple health and safety skills and to participate in simple activities.[] 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. As adults, they may work in a sheltered workshop.[] A person with severe or profound mental retardation will need more intensive support and supervision his or her entire life.[] They may learn some activities of daily living. Some will require full-time care by an attendant.[]
Cause
Among children, the cause is unknown for one-third to one-half of cases.[] Down syndrome, velocariofacial syndrome, and fetal alcohol 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. The most prevalent genetic conditions include Down syndrome, Klinefelter's syndrome, Fragile X syndrome (common among boys), Neurofibromatosis, congenital hypothyroidism, Williams syndrome, Phenylketonuria (PKU), and Prader-Willi syndrome. Other genetic conditions include Phelan-McDermid syndrome (22q13del), Mowat-Wilson syndrome, genetic ciliopathy,[15] and Siderius type X-linked mental retardation (OMIM 300263 [16]) as caused by mutations in the PHF8 gene (OMIM 300560 [17] [18][19] ). In the rarest of cases, abnormalities with the X or Y chromosome may also cause disability. 48,
Mental retardation XXXX and 49, XXXXX syndrome affect a small number of girls worldwide, while boys may be affected by 47, XYY, 49, XXXXY, or 49, XYYYY. Problems during pregnancy. Mental 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. 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. Exposure to certain types of disease or toxins. Diseases like whooping cough, measles, or meningitis can cause mental disability if medical care is delayed or inadequate. Exposure to poisons like lead or mercury may also affect mental ability. Iodine deficiency, affecting approximately 2billion 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 500million suffering from deficiency, 54million from goiter, and 2million from cretinism. Among other nations affected by iodine deficiency, China and Kazakhstan have instituted widespread iodization programs, whereas, as of 2006, Russia had not.[20] Malnutrition is a common cause of reduced intelligence in parts of the world affected by famine, such as Ethiopia.[21] Absence of the arcuate fasciculus.[22]
Diagnosis
According to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV),[23] three criteria must be met for a diagnosis of mental retardation: an IQ below 70, significant limitations in two or more areas of adaptive behavior (as measured by an adaptive behavior rating scale, i.e. communication, self-help skills, interpersonal skills, and more), and evidence that the limitations became apparent before the age of 18. It is formally diagnosed by professional assessment of intelligence and adaptive behavior.
IQ below 70
The first English-language IQ test, the Terman-Binet, was adapted from an instrument used to measure potential to achieve developed by Binet in France. Terman translated the test and employed it as a means to measure intellectual capacity based on oral language, vocabulary, numerical reasoning, memory, motor speed and analysis skills. The mean score on the currently available IQ tests is 100, with a standard deviation of 15 (WAIS/WISC-IV) or 16 (Stanford-Binet). Sub-average intelligence is generally considered to be present when an individual scores two standard deviations below the test mean. Factors other than cognitive ability (depression, anxiety, etc.) can contribute to 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 Standard Scores of intelligence tests, reflect the categories of the American Association of Mental Retardation, the Diagnostic and Statistical Manual of Mental Disorders-IV-TR, and the International Classification of Diseases-10[citation needed]:
Mental retardation
Class Profound mental retardation Severe mental retardation Moderate mental retardation Mild mental retardation Borderline intellectual functioning
Since the diagnosis is not based on IQ scores alone, but must also take into consideration a person's adaptive functioning, the diagnosis is not made rigidly. It encompasses intellectual scores, adaptive functioning scores from an adaptive behavior rating scale based on descriptions of known abilities provided by someone familiar with the person, and also the observations of the assessment examiner who is able to find out directly from the person what he or she can understand, communicate, and such like. This enables diagnosis to avoid the pitfall of the Flynn Effect which is a consequence of a periodic re-calibration of average IQ (usually upwards) affecting the absolute values of the standard deviation causing some people to fall into a different IQ range as-if overnight.
Management
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 around the world 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 rehabilitation 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. There are also many agencies and programs for parents of children with developmental disabilities. 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
Mental retardation 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. Although there is no specific medication for mental retardation, 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. Use of psychotropic medications such as benzodiazepines in people with mental retardation requires monitoring and vigilance as side effects occur commonly and are often misdiagnosed as behavioural and psychiatric problems.[24]
Epidemiology
Mental retardation affects about 23% of people.[] 7590% of the affected people have mild retardation.[] Non-syndromic or idiopathic MR accounts for 3050% of cases.[] About a quarter of cases are caused by a genetic disorder.[]
Mental retardation became popular throughout the world. This led to forced sterilization and prohibition of marriage in most of the developed world and was later used by Hitler as rationale for the mass murder of mentally challenged individuals during the holocaust. Eugenics was later abandoned as an evil violation of human rights, and the practice of forced sterilization and prohibition from marriage was discontinued by most of the developed world by the mid 20th century. In 1905, Alfred Binet produced the first standardized test for measuring intelligence in children.[] Although ancient Roman law had declared people with mental retardation 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 the developmentally disabled as a major organizational emphasis in 1952. Their earliest efforts included workshops for special education teachers and daycamps for disabled children, all at a time when such training and programs were almost nonexistent.[25] The segregation of people with developmental disabilities wasn't widely questioned by academics or policy-makers until the 1969 publication of Wolf Wolfensberger's seminal work "The Origin and Nature of Our Institutional Models",[26] drawing on some of the ideas proposed by SG Howe 100 years earlier. This book posited that society characterizes people with disabilities as deviant, sub-human and burdens of charity, resulting in the adoption of that "deviant" role. Wolfensberger argued that this dehumanization, and the segregated institutions that result from it, ignored the potential productive contributions that all people can make to society. He pushed for a shift in policy and practice that recognized the human needs of "retardates" and provided the same basic human rights as for the rest of the population. 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. Successful lawsuits against governments and an increasing awareness of human rights and self-advocacy also contributed to this process, resulting in the passing in the U.S. of the Civil Rights of Institutionalized Persons Act in 1980. From the 1960s to the present, most states have moved towards the elimination of segregated institutions. Normalization and deinstitutionalization are dominant.[] Along with the work of Wolfensberger and others including Gunnar and Rosemary Dybwad,[27] a number of scandalous revelations around the horrific conditions within state institutions created public outrage that led to change to a more community-based method of providing services.[28] 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 most countries, this was essentially complete by the late 1990s, although the debate over whether or not to close institutions persists in some states, including Massachusetts.[29] In the past, lead poisoning and infectious diseases were significant causes of intellectual disabilities. Some causes of mental retardation are decreasing, as medical advances, such as vaccination, increases. Other causes are increasing as a proportion of cases, perhaps due to rising maternal age, which is associated with several syndromic forms of mental retardation. 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. This phenomenon is shared with mental health and motor disabilities, and seen to a lesser degree in sensory disabilities.[citation needed]
Mental retardation
Mental retardation other living skills in a sheltered setting, such as a group home. In many areas, these terms have been replaced by use of "moderate" and "severe" mental retardation. While the names change, the meaning stays roughly the same in practice. Retarded comes from the Latin retardare, "to make slow, delay, keep back, or hinder," so mental retardation means the same as mentally delayed. The term was recorded in 1426 as a "fact or action of making slower in movement or time." The first record of retarded in relation to being mentally slow was in 1895. The term retarded was used to replace terms like idiot, moron, and imbecile because retarded was not (then) a derogatory term. By the 1960s, however, the term had taken on a partially derogatory meaning as well. The noun retard is particularly seen as pejorative; as of 2010, the Special Olympics, Best Buddies and over 100 other organizations are striving to eliminate the use of the "r-word" (analogous to the "n-word") in everyday conversation.[31][32] The term mental retardation is a diagnostic term denoting the group of disconnected categories of mental functioning such as idiot, imbecile, and moron derived from early IQ tests, which acquired pejorative connotations in popular discourse. The term mental retardation acquired pejorative and shameful connotations over the last few decades due to the use of the words retarded and retard as insults. This may have contributed to its replacement with euphemisms such as mentally challenged or intellectually disabled. While developmental disability includes many other disorders (see below), developmental disability and developmental delay (for people under the age of 18), are generally considered more polite terms than mental retardation.
United States
In North America mental retardation is subsumed into the broader term developmental disability, which also includes epilepsy, autism, cerebral palsy and other disorders that develop during the developmental period (birth to age 18). Because service provision is tied to the designation developmental disability, it is used by many parents, direct support professionals, and physicians. In the United States, however, in school-based settings, the more specific term mental retardation is still typically used, and is one of 13 categories of disability under which children may be identified for special education services under Public Law 108-446. The phrase intellectual disability is increasingly being used as a synonym for people with significantly below-average cognitive ability. 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 may also refer to the outcome of traumatic brain injury, lead poisoning, or dementing conditions such as Alzheimer's disease. It is not specific to congenital disorders such as Down syndrome. The American Association on Mental Retardation continued to use the term mental retardation until 2006.[33] In June 2006 its members voted to change the name of the organization 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 members worked with people with pervasive developmental disorders, most of whom do not have mental retardation.[34]
United Kingdom
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 for the United Kingdom from 199597, changed the NHS's designation to learning disability.[35] 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.[36] In education, "learning difficulties" is applied to a wide range of conditions: "specific learning difficulty" may refer to dyslexia, dyscalculia or dyspraxia, while "moderate learning difficulties", "severe learning difficulties" and "profound learning difficulties" refer to more significant impairments.[37][38]
Mental retardation In England and Wales between 1983 and 2008 the Mental Health Act 1983 defined "mental impairment" and "severe mental impairment" as "a state of arrested or incomplete development of mind which includes significant/severe impairment of intelligence and social functioning and is associated with abnormally aggressive or seriously irresponsible conduct on the part of the person concerned."[39] As behavior was involved, these were not necessarily permanent conditions: they were defined for the purpose of authorizing detention in hospital or guardianship. The term mental impairment was removed from the Act in November 2008, but the grounds for detention remained. However, English statute law uses mental impairment elsewhere in a less well-defined mannere.g. to allow exemption from taxesimplying that mental retardation without any behavioral problems is what is meant. A BBC poll conducted in the United Kingdom came to the conclusion that 'retard' was the most offensive disability-related word.[40] On the reverse side of that, when a contestant on Celebrity Big Brother live used the phrase "walking like a retard", despite complaints from the public and the charity Mencap, the communications regulator Ofcom did not uphold the complaint saying "it was not used in an offensive context [...] and had been used light-heartedly". It was however noted that two previous similar complaints from other shows were upheld.[41]
Australia
In the past, Australia has used British and American terms interchangeably, including "mental retardation" and "mental handicap". Today, "Intellectual disability" is the preferred and more commonly used descriptor.[42]
Until the middle of the 20th century, people with intellectual disabilities were routinely excluded from public education, or educated away from other typically developing children. Compared to students with intellectual disabilities who were segregated in special schools, students with intellectual disabilities who are mainstreamed or included in regular classrooms report similar levels of stigma and social self-conception, but more ambitious plans for employment.[] As adults, people with intellectual disabilities may live independently, with family members, or in different types of institutions organized to support people with intellectual disabilities. About 8% of people with mental retardation live in an institution or group home.[] In the US, the average lifetime cost of mental retardation amounts to $1,014,000 per person with mental retardation, in 2003 US dollars.[] This is slightly more than the costs associated with cerebral palsy, and double that associated with serious vision or hearing impairments. Of that $1,014,000, about 14% is due to increased medical expenses (not including what is normally incurred by the typical person), 10% is due to direct non-medical expenses, such as the excess cost of special education compared to standard schooling, and 76% is indirect costs accounting for reduced productivity and shortened lifespans. Some expenses, such as costs associated with being a family caregiver or living in a group home, were excluded from this calculation.[] Abusive terms for intellectual deficits are common insults, and are most commonly applied to non-disabled people. For example, in the 1964 movie Becket, King Henry II calls his son and heir a "cretin." Mental health professionals
Mental retardation discourage use of these terms. The abbreviation retard or tard is still used as a generic insult. A BBC survey in 2003 ranked retard as the most offensive disability-related word, ahead of terms such as spastic or its abbreviation spaz(which are not considered offensive in America[43]) and mong.[44] A campaign led by people with intellectual disabilities and the Special Olympics to eliminate the "R word" has resulted in federal legislation to replace the term mentally retarded with the term intellectual disability in some federal statutes.[45]
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References
[1] http:/ / apps. who. int/ classifications/ icd10/ browse/ 2010/ en#/ F70 [2] http:/ / apps. who. int/ classifications/ icd10/ browse/ 2010/ en#/ F79 [3] http:/ / www. icd9data. com/ getICD9Code. ashx?icd9=317 [4] http:/ / www. icd9data. com/ getICD9Code. ashx?icd9=319 [5] http:/ / www. diseasesdatabase. com/ ddb4509. htm [6] http:/ / www. nlm. nih. gov/ medlineplus/ ency/ article/ 001523. htm [7] http:/ / www. emedicine. com/ med/ topic3095. htm [8] http:/ / www. emedicine. com/ neuro/ topic605. htm# [9] http:/ / www. nlm. nih. gov/ cgi/ mesh/ 2013/ MB_cgi?field=uid& term=D008607 [10] Special Education Support Service [http://www.sess.ie/categories/general-learning-disabilities General Learning Disabilities [16] http:/ / www. ncbi. nlm. nih. gov/ entrez/ dispomim. cgi?id=300263 [17] http:/ / www. ncbi. nlm. nih. gov/ entrez/ dispomim. cgi?id=300560 [43] Spastic, learning disability (http:/ / separatedbyacommonlanguage. blogspot. com/ 2007/ 01/ spastic-learning-disability. html). Murphy, M. Lynne. 2007-02-28. Retrieved 2008-01-09. [45] "Spread the word to end the word" website (http:/ / www. r-word. org/ ) of the Special Olympics. The legislation was , sometimes known as "Rosa's Law."
External links
FAQ on intellectual disabilities (http://www.cdc.gov/ncbddd/dd/ddmr.htm) from the US Centers for Disease Control's National Center on Birth Defects and Developmental Disabilities
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License
Creative Commons Attribution-Share Alike 3.0 Unported //creativecommons.org/licenses/by-sa/3.0/