Mental retardation

Mental retardation (also called mental handicap and, as defined by the UK Mental Health Act 1983, mental impairment and severe mental impairment) 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) below 70.

People with mental retardation are usually described as having developmental disabilities.

Alternate terms
The term mental retardation has gradually acquired pejorative and shameful connotations over the last few decades and is now used almost exclusively in technical or scientific contexts where exactness is necessary.
 * In North America the broad term developmental delay has become an increasingly preferred synonym by many parents and caregivers. 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.
 * Intellectual disability is increasingly used as a synonym for people with significantly below-average IQ, primarily 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 continues to use the term mental retardation.

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,
 * not understand how to pay for things,
 * have trouble understanding social rules,
 * have trouble seeing the consequences of their actions,
 * have trouble solving problems, and/or
 * have trouble thinking logically.

In early childhood mild disability (IQ 60–70) may not be obvious, and may not be diagnosed until they 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. They will have trouble learning in school. 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, every child is able to learn, develop, and grow to some extent. The capacity to experience joy and human relationships is not IQ-dependent.

Diagnosis
According to the DSM-IV, 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, 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:

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 instruments that are actually structured interviews, with which they systematically elicit information about the person's functioning in the community from someone that 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, going to the bathroom, and feeding one's self;
 * communication skills, such as understanding what is said and being able to answer;
 * social skills with peers, family members, 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 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, and phenylketonuria (PKU).
 * Problems during pregnancy. Mental disability can result when the baby does not develop inside the mother properly. For example, there may be a problem with the way the baby'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.
 * Health problems. Diseases like whooping cough, measles, or meningitis can cause mental disability. It can also be caused by extreme malnutrition, not getting enough medical care, or by being exposed to poisons like lead or mercury.
 * Iodine deficiency is the leading preventable cause of mental disability in areas of the developing world where iodine deficiency is endemic.

Treatment and Assistance
By most definitions it is more accurately considered a disability rather than a disease. It can be distinguished in many ways from mental illness, such as schizophrenia or depression. 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. 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.

Traditional terms
Several traditional terms denoting varying degrees of mental deficiency long predate psychiatry. In common usage they are simple forms of abuse. Their now-obsolete use as psychiatric technical definitions is of purely historical interest. There have been some efforts made among mental health professionals to discourage use of these terms, but as long as intelligence is seen to contribute to social and financial success, children will use any term they believe to mean "stupid" as an insult. In addition to the terms below, the abbreviation retard or tard is still used as a generic insult, especially among children and young teens.
 * Cretin is the oldest and probably comes from an old French word for Christian. The implication was that even 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.
 * Idiot indicated the greatest degree of mental deficiency, 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 disability.
 * Imbecile indicated a mental 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.