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07-SEPTEMBER-2008 03:17:44 - retardation Semi-protected Mental retardation Classification and external resources ICD-10 F70.-F79. ICD-9 317-319 DiseasesDB 4509 eMedicine med/3095 neuro/605 MeSH D008607 Mental retardation is a generalized, triarchic disorder, characterized by subaverage cognitive functioning and deficits in two or more adaptive behaviors with onset before the age of 18. Once focused almost entirely on cognition, the definition now includes both a component relating to mental functioning and one relating to the individual's functional skills in their environment. Contents 1 Alternative terms 2 Signs 3 Diagnosis 3.1 IQ below 70 3.2 Significant limitations in two or more areas of adaptive behavior 3.3 Evidence that the limitations became apparent in childhood 4 Causes 5 Treatment and assistance 6 Archaic terms 7 References 8 External links Alternative terms The term mental retardation is a diagnostic term designed to capture and standardize a 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 over time. The term mental retardation has itself now acquired some pejorative and shameful connotations over the last few decades due to the use of retarded as an insult among younger people. This may in turn have contributed to its replacement with expressions such as mentally challenged or intellectual disability. 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 professional, and physicians. 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.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 may 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 disorders such as 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 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 are not mentally retarded.3 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 1995-7, changed the NHS'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/severe impairment of intelligence and social functioning and is associated with abnormally aggressive or seriously irresponsible conduct on the part of the person concerned.4 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 Children with mental retardation 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 mental retardation may also exhibit the following characteristics: Delays in oral language development Deficits in memory skills Difficulty learning social rules Difficulty with problem solving skills Delays in the development of adaptive behaviors such as self-help or self-care skills Lack of social inhibitors. The limitations of cognitive functioning will cause a child with mental retardation to learn and develop 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 participating members of the community. In early childhood mild mental retardation IQ 60-70 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. As individuals with mild mental retardation reach adulthood, many learn to live independently and maintain gainful employment. Moderate mental retardation IQ 50-60 is nearly always apparent within the first years of life. Children with moderate mental retardation will require considerable supports in school, at home, and in the community in order to participate fully. 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. A person with a more severe mental retardation will need more intensive support and supervision his or her entire life. Diagnosis According to the latest ion of the Diagnostic and Statistical Manual of Mental Disorders DSM-IV,5 there are three criteria before a person is considered to have a 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 a person's intellectual capacity based on their 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 deviatons 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 the Wechsler Adult Intelligence Scale WAIS, were favored at one time, but are rarely used now: 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. The most prevalent genetic conditions include Down syndrome, Klinefelter syndrome, Fragile X syndrome, Neurofibromatosis, Hypothyroidism congenital, Williams syndrome, Phenylketonuria, Prader-Willi syndrome. Other genetic conditions include Phelan-McDermid syndrome 22q13del, Mowat-Wilson syndrome, genetic ciliopathy6 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, whereas Russia has not. 7 Malnutrition is a common cause of reduced intelligence in parts of the world affected by famine, such as Ethiopia. 8 Very rare conditions that are X/Y linked. In girls it can be 48, XXXX only affecting 100 women worldwide, 49, XXXXX only affecting 25 women worldwide syndrome's. In boys it can be 46, XYY, 49, XXXXY, or 49, XYYYY. 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. Archaic terms Several traditional terms denoting varying degrees of mental deficiency long predate psychiatry, but have since been subject to the euphemism treadmill. In common usage they are simple forms of abuse. Their now-obsolete use as psychiatric technical definitions is of purely historical interest. They are often encountered in old documents such as books, academic papers, and census forms for example, the British census of 1901 has a column heading including the terms imbecile and feeble-minded. There have been some efforts made among mental health professionals to discourage use of these terms. Nevertheless their use persists. In addition to the terms below, the abbreviation retard or tard is still used as a generic insult, especially among children and teens. A BBC survey in 2003 ranked retard as the most offensive disability-related word, ahead of terms such as spastic not considered offensive in America9 and mong.10 Cretin is the oldestcitation needed and comes from a dialectal French word for Christian.11 The implication was that people with significant intellectual or developmental disabilities were still human or still Christian and deserved to be treated with basic human dignity. This term has not been used in any serious or scientific endeavor since the middle of the 20th century and is now always considered a term of abuse: notably, in the 1964 movie Becket, King Henry II calls his son and heir a cretin. Cretinism is also used as an obsolescent term to refer to the condition of congenital hypothyroidism, in which there is some degree of mental retardation. Idiot indicated the greatest degree of intellectual disability, where the mental age is two years or less, and the person cannot guard himself or herself against common physical dangers. The term was gradually replaced by the term profound mental retardation. Imbecile indicated an intellectual disability less extreme than idiocy and not necessarily inherited. It is now usually subdivided into two categories, known as severe mental retardation and moderate mental retardation. Moron was defined by the American Association for the Study of the Feeble-minded in 1910, following work by Henry H. Goddard, as the term for an adult with a mental age between eight and twelve; mild mental retardation is now the term for this condition. Alternative definitions of these terms based on IQ were also used. This group was known in UK law from 1911 to 1959/60 as feeble-minded. In the field of special education, Educable or educable mentally retarded refers to MR students with IQs of approximately 50-75 who can progress academically to a late elementary level. Trainable or trainable mentally retarded refers to students whose IQs fall below 50 but who are still capable of learning personal hygiene and other living skills in a sheltered setting, such as a group home. In many areas, these terms have fallen out of favor in favor of severe and moderate mental retardation. While the names change, the meaning stays roughly the same in practice. Usage has changed over the years, and differed from country to country, which needs to be borne in mind when looking at older books and papers. For example, mental retardation in some contexts covers the whole field, but used to apply to what is now the mild MR group. Feeble-minded used to mean mild MR in the UK, and once applied in the US to the whole field. Borderline MR is not currently defined, but the term may be used to apply to people with IQs in the 70s. People with IQs of 70 to 85 used to be eligible for special consideration in the US public education system on grounds 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. References ^ MENCAP: Website of the UK's leading learning disability charity. Retrieved 28 June 2006 ^ AAIDD POSITION STATEMENTS. Retrieved on 2007-08-23. ^ Chakrabarti S,Fombonne E 2001. Pervasive developmental disorders in preschool children. JAMA 285 24: 3093-9. doi:10.1001/jama.285.24.3093. PMID 11427137. ^ DRAFT ILLUSTRATIVE CODE OF PRACTICE. Retrieved on 2007-08-23. ^ eMedicine - Mental Retardation : Article by C Simon Sebastian, MD. Retrieved on 2007-08-23. ^ Badano, Jose L.; Norimasa Mitsuma, Phil L. Beales, Nicholas Katsanis September 2006. The Ciliopathies : An Emerging Class of Human Genetic Disorders. Annual Review of Genomics and Human Genetics 7: 125-148. doi:10.1146/annurev.genom.7.080505.115610. Retrieved on 2008-06-15. ^ 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 ^ Malnutrition Is Cheating Its Survivors, and Africa's Future article in the New York Times by Michael Wines, December 28, 2006 ^ spastic, learning disability. Murphy, M Lynne. 2007-02-28. Retrieved 2008-01-09. ^ BBC 2003. Worst Word Vote HTML. Ouch. Retrieved on 2007-08-17. ^ cretin HTML. The American Heritage® Dictionary of the English Language, Fourth ion. Houghton Mifflin Company 2006. Retrieved on 2008-08-04. External links Look up Retard in Wiktionary, the free dictionary. Mental Retardation Research Center National Center on Birth Defects and Developmental Disabilities The Arc Special Olympics v d e WHO ICD-10 mental and behavioral disorders F · 290-319 Neurological/symptomatic Dementia Alzheimer's disease, multi-infarct dementia, Pick's disease, Creutzfeldt-Jakob disease, Huntington's disease, Parkinson's disease, AIDS dementia complex, Frontotemporal dementia, Elopement, Sundowning, Wandering · Delirium · Post-concussion syndrome · Organic brain syndrome Psychoactive substance alcohol drunkenness, alcohol dependence, alcoholic hallucinosis, Alcohol withdrawal, delirium tremens, Korsakoff's syndrome, alcohol abuse · opioids opioid dependency · sedative/hypnotic benzodiazepine withdrawal · cocaine cocaine dependence · general Intoxication, Drug abuse, Physical dependence, Withdrawal Psychotic disorder Schizophrenia disorganized schizophrenia · Schizophreniform disorder · Schizotypal personality disorder · Delusional disorder · Folie à deux · Schizoaffective disorder Mood affective Mania · Bipolar disorder · Clinical depression · Cyclothymia · Dysthymia Neurotic, stress-related and somatoform Anxiety disorder Agoraphobia, Panic disorder, Panic attack, Generalized anxiety disorder, Social anxiety, Social phobia · OCD · Acute stress reaction · PTSD · Adjustment disorder · Conversion disorder Ganser syndrome · Somatoform disorder Somatization disorder, Body dysmorphic disorder, Hypochondriasis, Nosophobia, Da Costa's syndrome, Psychalgia · Neurasthenia Physiological/physical behavioral Eating disorder: Anorexia nervosa · Bulimia nervosa Sleep disorder: Dyssomnia Hypersomnia, Insomnia · Parasomnia REM behavior disorder, Night terror · Nightmare Sexual dysfunction: Erectile dysfunction · Premature ejaculation · Vaginismus · Dyspareunia · Hypersexuality · Female sexual arousal disorder Postpartum depression · Postnatal psychosis Adult personality and behavior Personality disorder · Passive-aggressive behavior · Kleptomania · Trichotillomania · Voyeurism · Factitious disorder · Munchausen syndrome · Ego-dystonic sexual orientation · Fetishism Mental retardation Mental retardation Psychological development developmental disorder Specific: speech and language expressive language disorder, aphasia, expressive aphasia, receptive aphasia, Landau-Kleffner syndrome, lisp · Scholastic skills dyslexia, dysgraphia, Gerstmann syndrome · Motor function developmental dyspraxia Pervasive: Autism · Rett syndrome · Asperger syndrome Behavioral and emotional, childhood and adolescence onset ADHD · Conduct disorder · Oppositional defiant disorder · Separation anxiety disorder · Selective mutism · Reactive attachment disorder · Tic disorder · Tourette syndrome · Speech stuttering · cluttering Retrieved from http://en..org/wiki/Mental_retardation Categories: Childhood psychiatric disorders | DisabilityHidden categories: Semi-protected | All articles with statements | Articles with statements since August 2008 Views Article Discussion View source History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages ÄŒesky Deutsch Español Français Galego Hrvatski Italiano עברית Nederlands 日本語 Polski Português РуÑ?Ñ?кий SlovenÄ?ina СрпÑ?ки / Srpski Suomi Svenska УкраїнÑ?ька ä¸æ–‡ This page was last modified on 26 August 2008, at 21:5
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