Mental retardation, which is also called developmental delay, is a condition of major clinical and social importance. The condition is characterized by a limitation of performance due to a significant impairment in measured intelligence. There is also an impairment of adaptive behavior for age. Unfortunately, a teen labeled with mental retardation may suffer more handicapping consequences in social status than from the specific condition itself.
According to authorities in the field, between one to three percent of adolescents will have some degree of mental retardation. Previously, mental retardation was characterized as mild, moderate, severe or profound. Recently, the American Association on Mental Retardation has classified mental retardation into the specific amount of support systems needed by the individual for daily functioning. The level of support is classified as intermittent, limited, extensive and pervasive.
A teen with a limitation of measured intelligence may not be diagnosed with mental retardation if there is no impairment of adaptive behavior. Adaptive behavior refers to how well an individual copes with common life demands. In addition, one evaluates how well the individual meets the standards of personal independence that is expected of someone at the same age, sociocultural background and community setting.
Who is likely to develop mental retardation?
Any adolescent’s abilities are influenced by the integrity and maturational status of his or her nervous system as well as the quality of his or her life experiences. This reflects the influence of nature and nurture. There are known causes of mental retardation, and these are classified into seven areas.
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Preconception disorders: may include a defective gene or chromosome that is present before conception occurs. This could include tuberous sclerosis (TS), which is inherited as an autosomal dominant trait. The gene for TS is located on a chromosome either in the sperm or the egg.
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Early embryonic disruption: this could include an early infection in the embryo such as rubella or a disruption in the chromosomes such as Down Syndrome (trisomy 21).
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Fetal brain insult: this may be due to a toxin such as maternal use of alcohol or cocaine.
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Perinatal problems: extreme prematurity, oxygen problems around the time of birth or infection may be result in mental retardation
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Postnatal brain insults: this may result from severe injury to the developing brain, infection, bleeding or lead poisoning.
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Postnatal life experience issues: severe poverty, parental mental health issues or substance abuse and dysfunctional infant-caregiver interactions may result in mental retardation.
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Unknown causes
What are the symptoms of mental retardation?
Adolescents with mental retardation will have a spectrum of symptoms. Most teens with mental retardation fit in what was previously referred to as the “educable” or mild category. By their late teens, these adolescents can acquire academic skills up to the sixth grade level. They do achieve social and vocational skills adequate for minimum self-support. With appropriate support, these individuals may live either independently or in supervised settings.
At a more significant level of mental retardation, individuals have difficulties in recognizing social conventions. This, in turn, interferes with peer relationships. Under close supervision in a sheltered workshop, most of these individuals are able to perform unskilled or semiskilled work.
About three to four percent of individuals with mental retardation have a more severe degree of impairment. They may learn to talk and are able to do limited self-care. Most adapt well to life in a group home or with their family.
The most severe form of mental retardation occurs in one to two percent of individuals afflicted with the disorder. Usually there is an identifiable cause and associated neurological condition. These individuals usually have their most optimal development in highly structured environments with constant aid and supervision.
How is mental retardation evaluated?
The initial evaluation of an individual with possible mental retardation begins with the primary care clinician. Parental and teacher reports of skills and behaviors are reviewed in conjunction with a thorough history and physical examination. Laboratory tests may be ordered based on the information obtained from the history and physical examination. For example, if a patient is thought to have Down Syndrome, then a study of chromosomes can be ordered. Or if a patient has a possible seizure disorder or severe language impairment, than an electroencephalogram could be ordered.
The diagnosis, however, of mental retardation does depend on confirmation of sub average general intellectual functioning. As a result, consultation with a psychologist or other appropriate professional is needed. In addition, there must be a deficit in two or more of the following adaptive skill areas:
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Communications
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Self-care
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Home living
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Social skills
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Community use
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Self-direction
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Health and safety
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Functional academics
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Leisure
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Work
How is mental retardation treated?
The core treatment for teens afflicted with mental retardation is specialized educational and therapeutic services. These should be instituted as early in childhood as possible in early intervention programming and then continued at the local school system. Services could include communications training, social skills, academics, physical and occupational therapies. The services must be tailored to the individual.
Adolescence presents new issues especially around sexuality, vocational training and community living. In addition, there are issues around independence and rebellion, self-esteem, adaptive physical education and athletics and many others. The teen with mental retardation should be followed not only by a primary care clinician interested in adolescents, but appropriate professionals and support services.
Teens who have mental retardation, like their normally developing peers, need information about appropriate sexual behavior. Also, they may require prescriptions or devices to prevent unwanted contraception. As an adolescent with mental retardation approaches adulthood, he or she will need continuing social, recreational, vocational, financial and legal services. This is especially important for the teen who plans to live independent of the family.
How is mental retardation prevented?
Some disorders that cause mental retardation may be diagnosed through prenatal studies including ultrasound, amniocentesis or chorionic villus biopsy. In the case of diagnosis, then complete information and appropriate medical management are essential.
It is important to give the developing embryo and fetus an environment as free as possible from toxins such as alcohol or infections. For example, all women should be counseled about alcohol usage and have immunity to rubella prior to conception.
In order to prevent mental retardation, promotion of healthy brain development should occur in all families and to all children. This requires a nurturing and growth-promoting environment for all. Since teens with mild mental retardation are disproportionately more prevalent in lower socioeconomic groups, prevention efforts should be aimed at children in poverty. Increasing access to prenatal care, pediatric services and family support are programs that may help to prevent mental retardation.
Related topics:
Academics, alcoholism in a parent, autism, brain disorders, cocaine and crack, disabilities, growth and development, independence and rebellion, learning disorders, safer sex, self-esteem
