MENTAL RETARDATION

Mental retardation (MR) is a developmental disability, defined by looking at three aspects of a child. IQ score, adaptive functioning, and the age of onset determine where a child lies in the continuum of mental retardation.

A numerical component of MR is defined by an IQ intelligence test. An IQ test measures and predicts how well individuals learn in their environment. The average IQ score of a typical developing child falls between 80 and 119. An IQ score below 70 to 75 characterizes a child for further evaluations to determine if the child is mentally retarded. IQ levels below 75 are categorized into several levels. These levels represent the amount of support individuals with MR require. The four levels of support include: intermittent (IQ score 55-65), limited (IQ score 35-55), extensive (IQ score 25-35), and pervasive (IQ score 20-25).

Adaptive functioning, the way an individual functions in society, is another aspect required for a valid definition of MR. Included in adaptive functioning are intellectual, emotional, physical, and environmental considerations. Daily living skills such as dressing, personal hygiene, eating, and receptive and expressive communication, as well as safety awareness and other basic skills, are evaluated for adaptive functioning. A child must show poor development in at least two of the adaptive functioning categories to be considered mentally retarded.

The last aspect for a definition of MR is the age of onset of the preceding characteristics. Under the definition of MR from the American Association on Mental Retardation, the age of onset has to be in childhood before the age of eighteen. As discussed in the following section, MR can develop even before the baby is born.

Individuals who fall below the IQ standard, show poor adaptive functioning in two or more areas, and had the onset of these conditions occur in childhood are considered to be mentally retarded. This does not mean that the individual will not learn and develop but, instead, that intervention will be necessary to assist the individual with his or her development.

Causes of Mental Retardation

Individuals affected by MR comprise between 1 percent and 3 percent of the population. Mental retardation can be acquired from any of the following categories: prenatal, perinatal (at the time of birth), postnatal, and economic status.

Prenatal, or before birth causes, can be broken down into genetics, disturbances in the embryonic development, and acquired causes. MR is associated with more than 500 genetic diseases. Examples of genetically inherited MR are too many chromosomes, too few, and a combination of defective genes and abnormal genes inherited from the parents. Disturbances in the embryonic development include multiple birth defects as well as specific syndromes. Acquired causes include infections during the pregnancy; the mother drinking, smoking, or taking other drugs, including some prescribed medications; and other maternal health issues. If the mother's health is in jeopardy, it in turn jeopardizes the unborn child's health. Drinking, smoking, drug usage, malnutrition, and contraction of HIV all affect the fetus.

All of these health hazards can cause damage such as low birthweight, mental retardation, and other neurological damage.

Perinatal causes of MR include premature birth (birth before thirty-six weeks gestation), low birth-weight, deprivation of oxygen to the fetus, and any undue stress put on the fetus at the time of birth.

Postnatal causes of MR include environment toxins and exposure to a childhood disease. There are vaccinations available to prevent the newborn from contracting damaging diseases. Whooping cough, measles, rubella, and mumps are all common childhood diseases for which the child can be immunized. Meningitis is another very serious disease that attacks the covering of the brain and spinal cord. This viral infection can cause permanent brain damage in infants. Any injury to the brain, including abuse or accident, can cause profound trauma to the developing brain. Toxins in the environment are also a cause of postnatal MR. One of the most important toxins is lead, the presence of which in paint has been a continuing issue. Symptoms of lead poisoning include lethargy, anemia, seizures, brain damage, and even death. Once lead poisoning is diagnosed, medications can assist with removing excess lead from the body. Even with medication, however, mental retardation may still be present.

The last category of causes of mental retardation is economic status. If a family lives in poor environmental conditions, the children in that family are at higher risk for disease, malnutrition, insufficient medical care, and understimulation, which can all lead to MR. Research has found that understimulation of the brain can cause irreversible damage to the brain and can lead to MR. Interacting with children is especially important in the first years of life to develop the neurons.

Prevention of Mental Retardation

The degree to which MR can be prevented has grown with the increased quality and quantity of medical technology, as well as the amount of education presented to expectant mothers. Technology allows medical staff access to the baby in the uterus. The amniotic fluid can be tested to determine some forms of defect in the fetus. Ultrasound allows the medical staff to see the baby in the uterus and determine if there is a physical defect. If a defect is found through one of these technologies, early intervention can be implemented either while the fetus is still in the uterus or directly after birth.

In addition to the prenatal techniques, newborn screenings have provided well over 2,000 newborns the opportunity for typical development. These screenings can prevent phenylketonuria (PKU), congenital hypothyroidism, Rh disease, and other abnormalities. PKU occurs in approximately 1 of every 14,000 births in the United States. PKU is a genetic disorder that causes difficulty for the body in breaking down the common food chemical, phyenylalanine. When phyenylalanine, an amino acid, builds up it can cause serious health and learning problems. Other preventive measures used to prevent mental retardation include reducing the presence of lead in the environment, using helmets and child safety seats, and educating people about the importance of using safety equipment. In addition, ensuring proper prenatal care for all pregnant women and seeking genetic counseling if there is history of birth defects will help prevent MR.

Public Policy Regarding Mental Retardation

Legislation passed in 1990 provided a clear path for the elimination of discrimination against people with disabilities. The Americans with Disabilities Act (ADA) protects persons with disabilities from discrimination in employment, government, public accommodations, commercial facilities, transportation, and telecommunications. The effectiveness of ADA lies with the advocates of this legislation. Demanding the compliance of every agency involved in the process is the advocate's responsibility. As each year passes, there will likely be fewer barriers for persons with disabilities.

Additional legislation includes IDEA (Individuals with Disabilities Education Act). IDEA states that every child, regardless of disability, will be provided a "free appropriate public education" in the "least restrictive environment to the maximum extent appropriate." Thus, children with disabilities are entitled to an education at public expense, with the added stipulation that the children be in the most contact possible with their nondisabled peers. This legislation was built on the existing public law 94-142 (PL 94-142), which ensures a child with a disability an individualized education plan (IEP). An IEP includes services the child requires, such as speech therapy and occupational therapy, as well as the child's goals and benchmarks to meet the goals.

PL 94-142 services begin from the child's third birthday. Before that, public law 99-457 (PL 99-457) serves children from birth through age two. Under these laws, states receive grants to provide services to children with disabilities. PL 99-457 requires an individualized family service plan (IFSP), which is similar to an IEP, except that instead of being child centered, it is family centered. Families with children who are disabled often require extra support and training. Included in the IFSP are teaching strategies for the parents as well as educating the siblings in how to interact with and understand their sibling with a disability.

The Future of Accommodating Mental Retardation

Before these laws were passed, children with disabilities had a very difficult time gaining an education. Society underestimated their learning capabilities. The few chances children with disabilities were given to learn were unsuccessful because of the lack of an appropriate teaching method.

Today, there is the opportunity to start early intervention from birth. There is greater understanding about mental retardation and how it affects brain development, which in turn enables society to make the necessary accommodations for both children and adults with disabilities. Early intervention provides a stronger foundation for the child to learn and develop skills later in life.

Agencies throughout the United States and in other countries provide continuous services to families who qualify. The Association for Retarded Citizens, which was started in the 1950s, is one such organization. These services provide employment opportunities, socialization opportunities, and daily living assistance to adults with disabilities. The ultimate goal of these agencies is to teach the adult how to function as a part of society and with the most independence possible.

Conclusions

Since the 1960s, when President John F. Kennedy spoke of his public support of people with mental retardation, the field of knowledge has expanded. This is due at least in part to people with MR presenting their acquired skills in the areas of education, employment, and athletics. These people have shown that, when provided with the right opportunities, they will rise to the occasion and take advantage of their opportunities.

Society has advanced from institutionalization of persons with MR to independent living in some cases. The expansion of education from segregation to inclusion has benefited many students with MR, as well as their typically developing peers. As technology continues to move forward, more advances will take place within the realm of MR. The more skills learned by people with MR, the more opportunities they will be given. In accordance with the law, and a better understanding of MR, prospects for the future of people with MR look very bright.

See also: DEVELOPMENTAL DISABILITIES

Bibliography

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Lisa A. Wertenberger