February 2004

Q: What is mental retardation?

A: Youth are described as being mentally retarded when their intellectual and adaptive-communication, self-care, social, and academic skills are significantly lower than that of their chronological peers. Mental retardation is not a disease. You can't catch it from anyone. There is no cure for mental retardation. It occurs in people of all races and ethnicities and is the most common developmental disorder, affecting about 1 percent of the general population. Almost one million youth have some level of retardation. It is not a type of mental illness, like depression. However, individuals who are mentally retarded have a prevalence of co-occurring emotional disorders that is estimated to be three to four times greater than that in the general population. Adequate epidemiological data regarding persons with both mental illness and mental retardation have yet to be gathered; however, clinical experience has shown that the full range of psychiatric disorders may be found among individuals with mental retardation. This includes co-occurrence with schizophrenia, affective disorders, obsessive-compulsive disorder, anxiety disorders, and behavior disturbances with injurious and aggressive behavior directed towards self, others, or objects. Proper identification and effective treatment of these mental disorders are especially important for people with mental retardation. In fact, although it is usually not possible to correct and reverse the underlying cognitive deficits, treatment of the behavioral and emotional problems that can be associated with mental retardation can significantly improve functioning and quality of life.

What Causes Mental Retardation?

Doctors have found many causes of mental retardation. The following are most common:

Genetic conditions. Sometimes mental retardation is caused by abnormal genes inherited from parents, errors when genes combine, or other reasons. Examples of genetic conditions are Down syndrome, fragile X syndrome, and phenylketonuria (PKU).

Problems during pregnancy . Mental retardation can result when a 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 or gets an infection such as rubella during pregnancy may also have a baby with mental retardation.

Problems at birth . If a baby has problems during labor and birth, such as not getting enough oxygen, he or she may have mental retardation.

Health problems . Diseases such as whooping cough, the measles, or meningitis can cause mental retardation. Mental retardation can also be caused by extreme malnutrition (not eating right), lack of enough medical care, or exposure to poisons such as lead or mercury.

How is Mental Retardation Diagnosed?

Mental retardation is diagnosed by looking at two main things:

• Intellectual functioning or intelligence quotient (IQ)-the ability of a person's brain to learn, think, solve problems, and make sense of the world. IQ is usually measured by a test called an IQ test. The average score is 100. People scoring below 70 are thought to have mental retardation.

• Adaptive functioning-the ability of a person to live independently (adaptive behavior or adaptive functioning) by having the following skills that he or she needs: daily living skills, such as getting dressed, going to the bathroom, and feeding himself or herself; communication skills, such as understanding what is said and being able to answer; social skills with peers, family members, adults, and others. A person whose adaptive functioning is age appropriate cannot be diagnosed as having mental retardation.

DSMIV DIAGNOSTIC CRITERIA

Degrees of Severity of Mental Retardation

Four degrees of severity can be specified: mild, moderate, severe, and profound

317 Mild Mental Retardation: IQ level from 50-55 to approximately 70

318.0 Moderate Retardation: IQ level from 35-40 to 50-55

318.1 Severe Mental Retardation: IQ level from 20-25 to 35-40

318.2 Profound Mental Retardation: IQ level below 20-25

317 Mild Mental Retardation

Mild mental retardation is roughly equivalent to what used to be referred to as the educational category of "educable." This group constitutes the largest segment (about 85 percent) of those with the disorder. As a group, people with this level of mental retardation typically develop social and communication skills during the preschool years (ages 0-5 years), have minimal impairment in sensorimotor areas, and often are not distinguishable from children without mental retardation until a later age. By their late teens, they can acquire academic skills up to approximately the sixth-grade level. During their adult years, they usually achieve social and vocational skills adequate for minimum self-support, but may need supervision, guidance, and assistance, especially when they are under unusual social or economic stress. With appropriate supports, individuals with mild mental retardation can usually live successfully in the community, either independently or in supervised settings.

318.0 Moderate Mental Retardation

Moderate mental retardation is roughly equivalent to what used to be referred to as the educational category of "trainable." This outdated term should not be used because it wrongly implies that people with moderate mental retardation cannot benefit from educational programs. This group constitutes about 10 percent of the entire population of people with mental retardation. Most of the individuals with this level of mental retardation acquire communication skills during early childhood years. They profit from vocational training and, with moderate supervision, can attend to their personal care. They can also benefit from training in social and occupational skills, but are unlikely to progress beyond the second-grade level in academic subjects. They may learn to travel independently in familiar places. During adolescence, their difficulties in recognizing social conventions may interfere with peer relationships. In their adult years, most are able to perform unskilled or semiskilled work under supervision in sheltered workshops or in the general workforce. They adapt well to life in the community, usually in supervised settings.

318.1 Severe Mental Retardation

The group with severe mental retardation constitutes 3 to 4 percent of individuals with mental retardation. During the early childhood years, they acquire little or no communicative speech. During the school-age period, they may learn to talk and can be trained in elementary self-care skills. They profit to only a limited extent from instruction in pre-academic subjects, such as familiarity with the alphabet and simple counting, but can master skills such as learning sight-reading of some "survival" words. In their adult years, they may be able to perform simple tasks in a closely supervised setting.

318.2 Profound Mental Retardation

The group with profound mental retardation constitutes 1 to 2 percent of individuals with mental retardation. Most individuals with the diagnosis have an identified neurological condition that accounts for their mental retardation. During the early childhood years, they display considerable impairments in sensorimotor functioning. In their adult years, they may be able to perform simple tasks in a closely supervised setting.

WHAT CAN PARENTS/CARETAKERS DO?

-Learn about mental retardation. The more you know, the more you can help yourself and your child.

-Encourage independence in your child. For example, help your child learn daily care skills, such as dressing, feeding him- or herself, using the bathroom, and grooming.

-Give your child chores. Keep her age, attention span, and abilities in mind. Break down jobs into smaller steps. For example, if your child's job is to set the table, first ask him or her to get the right number of napkins. Then have him or her put one at each family member's place at the table. Do the same with the utensils, going one at a time. Tell him or her what to do, step by step, until the job is done. Demonstrate how to do the job. Help him or her when he or she needs assistance. Give your child frequent feedback. Praise your child when he or she does well. Build your child's abilities.

-Find out what skills your child is learning at school. Find ways for your child to apply those skills at home. For example, if the teacher is going over a lesson about money, take your child to the supermarket with you. Help him or her count out the money to pay for your groceries. Help him or her count the change.

-Find opportunities in your community for social activities, such as scouts, recreation center activities, and sports. These will help your child build social skills as well as have fun.

-Talk to other parents whose children have mental retardation. Parents can share practical advice and emotional support. Call National Information Center for Children and Youth With Disabilities (NICHCY) at 1.800.695.0285 and ask how to find a parent group near you.

-Meet with the school staff to develop an educational plan to address your child's needs. Keep in touch with your child's teachers. Offer support. Find out how you can support your child's school learning at home.

-Insist that your child have a mental health evaluation and treatment, if warranted.

(NICHCY and the Journal of the American Association of Medicine provided most of this information . )

WHAT CAN MENTAL HEALTH PROFESSIONALS DO?

-Learn about dual diagnoses-mental retardation and emotional disorders. The more you know, the more you can help youth and families.

-Use appropriate assessment instruments to assess cognitive/adaptive and emotional functioning

-Use effective/evidence-based interventions (Refer to August, 2003 FAQ)

Technical Assistance Partnership for Child and Family Mental Health

Mental Health and Systems of Care Frequently Asked Questions

DSMIV DIAGNOSTIC CRITERIA

Degrees of Severity of Mental Retardation

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	February 2004 Q: What is mental retardation? A: Youth are described as being mentally retarded when their intellectual and adaptive-communication, self-care, social, and academic skills are significantly lower than that of their chronological peers. Mental retardation is not a disease. You can't catch it from anyone. There is no cure for mental retardation. It occurs in people of all races and ethnicities and is the most common developmental disorder, affecting about 1 percent of the general population. Almost one million youth have some level of retardation. It is not a type of mental illness, like depression. However, individuals who are mentally retarded have a prevalence of co-occurring emotional disorders that is estimated to be three to four times greater than that in the general population. Adequate epidemiological data regarding persons with both mental illness and mental retardation have yet to be gathered; however, clinical experience has shown that the full range of psychiatric disorders may be found among individuals with mental retardation. This includes co-occurrence with schizophrenia, affective disorders, obsessive-compulsive disorder, anxiety disorders, and behavior disturbances with injurious and aggressive behavior directed towards self, others, or objects. Proper identification and effective treatment of these mental disorders are especially important for people with mental retardation. In fact, although it is usually not possible to correct and reverse the underlying cognitive deficits, treatment of the behavioral and emotional problems that can be associated with mental retardation can significantly improve functioning and quality of life. What Causes Mental Retardation? Doctors have found many causes of mental retardation. The following are most common: *Genetic conditions.* Sometimes mental retardation is caused by abnormal genes inherited from parents, errors when genes combine, or other reasons. Examples of genetic conditions are Down syndrome, fragile X syndrome, and phenylketonuria (PKU). *Problems during pregnancy* . Mental retardation can result when a 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 or gets an infection such as rubella during pregnancy may also have a baby with mental retardation. *Problems at birth* . If a baby has problems during labor and birth, such as not getting enough oxygen, he or she may have mental retardation. *Health problems* . Diseases such as whooping cough, the measles, or meningitis can cause mental retardation. Mental retardation can also be caused by extreme malnutrition (not eating right), lack of enough medical care, or exposure to poisons such as lead or mercury. How is Mental Retardation Diagnosed? Mental retardation is diagnosed by looking at two main things: • Intellectual functioning or intelligence quotient (IQ)-the ability of a person's brain to learn, think, solve problems, and make sense of the world. IQ is usually measured by a test called an IQ test. The average score is 100. People scoring below 70 are thought to have mental retardation. • Adaptive functioning-the ability of a person to live independently (adaptive behavior or adaptive functioning) by having the following skills that he or she needs: daily living skills, such as getting dressed, going to the bathroom, and feeding himself or herself; communication skills, such as understanding what is said and being able to answer; social skills with peers, family members, adults, and others. A person whose adaptive functioning is age appropriate cannot be diagnosed as having mental retardation. DSMIV DIAGNOSTIC CRITERIA Degrees of Severity of Mental Retardation Four degrees of severity can be specified: mild, moderate, severe, and profound 317 Mild Mental Retardation: IQ level from 50-55 to approximately 70 318.0 Moderate Retardation: IQ level from 35-40 to 50-55 318.1 Severe Mental Retardation: IQ level from 20-25 to 35-40 318.2 Profound Mental Retardation: IQ level below 20-25 317 Mild Mental Retardation Mild mental retardation is roughly equivalent to what used to be referred to as the educational category of "educable." This group constitutes the largest segment (about 85 percent) of those with the disorder. As a group, people with this level of mental retardation typically develop social and communication skills during the preschool years (ages 0-5 years), have minimal impairment in sensorimotor areas, and often are not distinguishable from children without mental retardation until a later age. By their late teens, they can acquire academic skills up to approximately the sixth-grade level. During their adult years, they usually achieve social and vocational skills adequate for minimum self-support, but may need supervision, guidance, and assistance, especially when they are under unusual social or economic stress. With appropriate supports, individuals with mild mental retardation can usually live successfully in the community, either independently or in supervised settings. 318.0 Moderate Mental Retardation Moderate mental retardation is roughly equivalent to what used to be referred to as the educational category of "trainable." This outdated term should not be used because it wrongly implies that people with moderate mental retardation cannot benefit from educational programs. This group constitutes about 10 percent of the entire population of people with mental retardation. Most of the individuals with this level of mental retardation acquire communication skills during early childhood years. They profit from vocational training and, with moderate supervision, can attend to their personal care. They can also benefit from training in social and occupational skills, but are unlikely to progress beyond the second-grade level in academic subjects. They may learn to travel independently in familiar places. During adolescence, their difficulties in recognizing social conventions may interfere with peer relationships. In their adult years, most are able to perform unskilled or semiskilled work under supervision in sheltered workshops or in the general workforce. They adapt well to life in the community, usually in supervised settings. 318.1 Severe Mental Retardation The group with severe mental retardation constitutes 3 to 4 percent of individuals with mental retardation. During the early childhood years, they acquire little or no communicative speech. During the school-age period, they may learn to talk and can be trained in elementary self-care skills. They profit to only a limited extent from instruction in pre-academic subjects, such as familiarity with the alphabet and simple counting, but can master skills such as learning sight-reading of some "survival" words. In their adult years, they may be able to perform simple tasks in a closely supervised setting. 318.2 Profound Mental Retardation The group with profound mental retardation constitutes 1 to 2 percent of individuals with mental retardation. Most individuals with the diagnosis have an identified neurological condition that accounts for their mental retardation. During the early childhood years, they display considerable impairments in sensorimotor functioning. In their adult years, they may be able to perform simple tasks in a closely supervised setting. WHAT CAN PARENTS/CARETAKERS DO? -Learn about mental retardation. The more you know, the more you can help yourself and your child. -Encourage independence in your child. For example, help your child learn daily care skills, such as dressing, feeding him- or herself, using the bathroom, and grooming. -Give your child chores. Keep her age, attention span, and abilities in mind. Break down jobs into smaller steps. For example, if your child's job is to set the table, first ask him or her to get the right number of napkins. Then have him or her put one at each family member's place at the table. Do the same with the utensils, going one at a time. Tell him or her what to do, step by step, until the job is done. Demonstrate how to do the job. Help him or her when he or she needs assistance. Give your child frequent feedback. Praise your child when he or she does well. Build your child's abilities. -Find out what skills your child is learning at school. Find ways for your child to apply those skills at home. For example, if the teacher is going over a lesson about money, take your child to the supermarket with you. Help him or her count out the money to pay for your groceries. Help him or her count the change. -Find opportunities in your community for social activities, such as scouts, recreation center activities, and sports. These will help your child build social skills as well as have fun. -Talk to other parents whose children have mental retardation. Parents can share practical advice and emotional support. Call National Information Center for Children and Youth With Disabilities (NICHCY) at 1.800.695.0285 and ask how to find a parent group near you. -Meet with the school staff to develop an educational plan to address your child's needs. Keep in touch with your child's teachers. Offer support. Find out how you can support your child's school learning at home. -Insist that your child have a mental health evaluation and treatment, if warranted. (NICHCY and the Journal of the American Association of Medicine provided most of this information . ) WHAT CAN MENTAL HEALTH PROFESSIONALS DO? -Learn about dual diagnoses-mental retardation and emotional disorders. The more you know, the more you can help youth and families. -Use appropriate assessment instruments to assess cognitive/adaptive and emotional functioning -Use effective/evidence-based interventions (Refer to August, 2003 FAQ)