MILD AND MODERATE MENTAL RETARDATION - ECONOMÍA - 2025

The mental retardation is a disorder of the generalized neurodevelopmental characterized by a significant deterioration of intellectual and adaptive functioning. It is defined by an IQ score below 70, in addition to deficits in two or more adaptive behaviors that affect daily life.

Mental retardation is subdivided into syndromic, in which there are intellectual deficits associated with other medical signs and symptoms, and non-syndromic, in which intellectual deficits appear without other abnormalities. Down syndrome and Fragile X syndrome are examples of syndromic intellectual disabilities.

The terms mental disability and mental retardation were invented in the mid-20th century to replace the earlier set of terms, which were considered offensive. The term intellectual disability is now preferred by most advocates and researchers.

People with intellectual disabilities can learn new skills, but they do so more slowly. To measure a child's adaptive behaviors, a specialist will look at the child's abilities and compare them with other children of the same age.

General mental skills that are tested for the diagnosis of mental retardation include: reasoning, problem solving, planning, abstract thinking, judgment, learning from experience, and understanding. These skills are measured using individually administered intelligence tests that are given by a trained professional.

Mental retardation according to DSM

The DSM-IV-TR, diagnostic and statistical manual of mental disorders, speaks of mental retardation and includes it within disorders of onset in infancy, childhood or adolescence.

The definition of this developmental condition is addressed by the DSM based on a series of clinical criteria that must be present in a person for it to be diagnosed: significantly lower than average intellectual capacity and deficits or alterations of occurrence in adaptive activity current.

A. Significantly Below Average Intellectual Ability: An Intelligence Quotient (IQ) of approximately 70 or lower on an individually administered IQ test (for young children, a clinical judgment of significantly lower than average intellectual ability).

• Mild mental retardation: IQ between 50-55 and approximately 70.
• Moderate mental retardation: IQ between 35-40 and 50-55.
• Severe mental retardation: IQ between 20-25 and 35-40.
• Profound mental retardation: IQ less than 20-25.
• Mental retardation of unspecified severity: when there is a clear presumption of mental retardation, but the intelligence of the subject cannot be evaluated

  by the usual tests.

B. Deficit or alterations of occurrence in the current adaptive activity (effectiveness of the person to satisfy the demands made for their age and their cultural group), in at least two of the following areas: personal communication, domestic life, social / interpersonal skills, utilization of community resources, self-control, functional academic skills, work, leisure, health and safety.

C. Onset is prior to 18 years of age.

If these three criteria are met in a child or adolescent, he or she may be diagnosed with an intellectual development disorder (formerly, mental retardation).

I use this version of the DSM because, although it is old, it is the one used in the majority due to its pragmatism and the discontent among professionals of the fifth version of said diagnostic manual.

Causes of mental retardation

I speak in the plural because the causes that can trigger the alteration of intellectual development are very diverse. Some of them are:

• Genetic abnormalities: This category includes conditions such as Down syndrome or Fragile X syndrome.
• Problems During Pregnancy: There are factors during pregnancy that can interfere with normal brain development in the fetal stage. Some of them are drug use, malnutrition and certain infections.
• Problems at birth: Babies can sometimes be deprived of oxygen at the time of delivery, leading to brain damage. Within this category we could also include cases of abnormal development derived from extremely premature birth.
• Postnatal diseases: Certain diseases that occur after birth could also trigger abnormal brain development. These include meningitis, measles or whooping cough.
• Injuries: severe brain injuries, extreme malnutrition, lack of oxygen, exposure to toxic substances or abuse are also possible postnatal causes of abnormal intellectual development.
• Other unknown causes: in two-thirds of children with intellectual disabilities, the triggering cause is unknown.

Statistics

According to data from the National Institute of Statistics, 24,700 people in Spain are affected by mild intellectual deficiency (15,000 men and 9,800 women), 52,800 moderate intellectual deficiency (34,300 men and 18,400 women) and 47,000 profound and severe intellectual deficiency (24,100 men). and 23,000 women).

If we segment these data according to age, it is observed that the vast majority of affected people belong to the group of 6 to 64 years (23,300, 48,700 and 418,000 respectively), data that indirectly informs about their life expectancy collectives.

How is a diagnosis of mental retardation made?

Performing an electroencephalogram (EGG) can rule out brain abnormalities. Source: Baburov CC BY-SA 4.0

There are several ways in which a health professional might suspect or consider the presence of an intellectual development disorder.

1. An example is if a baby has physical abnormalities that suggest a genetic or metabolic cause. In this case, clinical tests will be done to confirm or refute the diagnosis:

• Blood and urine tests.
• MRI (magnetic resonance imaging) to detect structural abnormalities in the brain.
• EEG (electroencephalogram) to rule out functional abnormalities in the brain that may be related, for example, to epileptic seizures).

1. Another suspicion could be abnormalities in development, such as late acquisition of speech.

In this case, the doctor will focus on ruling out physical causes that may explain the anomaly, such as deafness in the aforementioned case. If, in addition to the physical causes, possible neurological disorders are also ruled out, it will be checked whether the person meets the criteria mentioned above for disorders of intellectual development.

In order to diagnose an intellectual development disorder, the evaluation of the above criteria must be done globally. That is, interviews with parents, observation of behavior and adaptation will be included, in addition to intelligence tests.

If only one of the criteria or one of the evaluation pathways is positive, the diagnosis will be ruled out.

If and only if the three criteria of the DSM are corroborated through the triple evaluation, the diagnosis of intellectual development disorder will be established.

Thus, in the clinic, a fusion is made between the descriptive precision of the DSM-IV criteria and the globalizing approach of the DSM-V in terms of evaluation.

Signs and symptoms

Although making a list of observable signs is, in this case, excessively general, I will present some of the most frequent:

• Late learning compared to most children (crawling, walking, sitting, talking).
• Speech abnormalities.
• Trouble remembering
• Difficulties in understanding the social environment (social norms) and in adapting to it.
• Anomalies or inability to solve problems.
• Difficulty in understanding and anticipating the consequence of their own actions.

As a general rule, these signs will be more noticeable and easier to identify at an earlier age if the intellectual development disorder is more serious.

In any case, given that there is a very high variability in the picture presented by these children, even though the cause of their developmental abnormality is the same, we cannot speak of common signs.

Is prevention possible?

Taking care of yourself during pregnancy lowers the risk of your baby having mental disabilities

If we review the possible causes we see that, in most cases, intellectual development disorders can be prevented.

The cause of intellectual development disorder associated with a higher success rate in prevention programs is fetal alcohol syndrome, caused by the mother's consumption of alcohol during pregnancy. Currently, the consumption habits of pregnant women are continuously monitored.

Other highly widespread prevention measures are the consumption of vitamins during pregnancy or the vaccination of the mother against infectious diseases highly related to abnormal intellectual development syndromes.

Although it is not yet as widespread as previous prevention tools, there are currently sophisticated genetic analyzes to determine the probability of hereditary diseases that occur with intellectual disabilities or other disorders.

However, many of the genetic abnormalities are due to “de novo” mutations: mutations that are not inherited by either parent but occur at the time of conception or at different stages of fetal development (failures in the replication of DNA).

The “mass sequencing” approach is the tool that is currently scientifically committed to detect any possible spectrum disorder in time. However, currently, only 60% of cases are identifiable using this sophisticated technology.

Why?

Despite the initial enthusiasm for genetic testing, it has been seen that the same syndrome of intellectual development can be activated through the same genes. Furthermore, the same genetic modification can lead to different syndromes or different degrees of involvement of the same syndrome.

Treatment

Therapeutic support for people with intellectual disabilities. Source: Mariasatrustegui

Acceptable treatment for disorders of intellectual development is multidisciplinary in approach. And what is that? Address the pathology with interventions from different health and social professionals at the same time:

• Educators in special needs.
• Speech therapists such as speech therapists.
• Behavioral therapists such as psychologists
• Occupational therapists
• Community services that provide social support and care to families, the immediate environment and affected members.

What can I do to help?

Include the child in group activities

• Learn all you can about the pathology. The more you know, the more you can help the affected person and family.
• Supports the child's independence. Never limit her exploration and provide her with opportunities to experiment with her surroundings and have new experiences.
• It serves as a guide for the child, not as a control tool. Whenever possible, for example if you are learning new things, provide positive feedback on your actions.
• Get the child to participate in group activities. This will help you develop capacities to adapt to the social environment.
• Communicate with your environment. By staying in contact with the people who are in charge of their treatment and evolution, you will be able to follow their progress and reinforce what the child has learned in other contexts.
• Connect with other people in the same situation. Other families who are going through a similar situation will serve as fundamental support and source of invaluable advice.

The big problem: attitudes towards intellectual disability

Child with intellectual disability crossing the finish line of the Special Olympic Games. Source: Public domain photograph from defenseimagery.mil.

As stated in the 2003 multinational study of attitudes towards individuals with intellectual disabilities, the general public does not understand the capacities of people with intellectual disabilities.

The observed reality reflects that people with mental health problems are subject to discrimination, even in health care settings, which has a negative impact on their self-esteem and degree of participation in society.

Several studies conclude that the best way to combat discrimination and stigma is through direct personal contact and social outreach campaigns.

The inclusive education movement:

The World Report on Disability states that students with severe intellectual disabilities who were taught in general education classes had better social outcomes.

If this is so for the most serious cases, why segregate even the mildest cases?

Intellectual development is not just a matter of how much you know or how many things you learn, it is also related to social inclusion. One of the greatest sources of learning and development is the social group. What I defend is not something new, Bandura already said in 1977 (vicarious apprenticeship).

In addition, it is not a question of me saying it or being defended by experts in the area, what we must not forget is the opinion and word of those affected:

References

1. Alcón, J. (2011). Free thinking for people with intellectual disabilities: I think, therefore I am one more program. Ediciones Pirámide, SA
2. American Psychiatric Association. (2001). DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders. Revised Text. Elsevier Masson.
3. CDC. Learn the signs. React soon.
4. Siperstein GN, Norins J, Corbin S, Shriver T. Multinational study of attitudes towards individuals with intellectual disabilities. Washington,

   Special Olympics Inc, 2003.