How Is Mental Retardation Diagnosed?

The term "mental retardation" (MR) refers to one of the most common forms of developmental disability. Idiopathic developmental deficits in otherwise healthy-appearing children might be difficult to diagnose. On the other hand, MR is easy to spot if the youngster has dysmorphic characteristics linked to a recognised genetic MR condition.  The American Association on Mental Retardation (AAMR) currently defines mental retardation as "significantly subaverage general intellectual functioning accompanied by significant limitations in adaptive functioning in at least two of the following skills areas: communication, self-care, self-direction, social skills, academic skills, work, leisure, health, and safety." It's clear that these restrictions exist before the age of eighteen. When there are also significant concerns regarding adaptive abilities, the AAMR defines the upper limit of subaverage general intellectual functioning as "70 to 75," acknowledging that a numerical value alone may not be precise or adequate to distinguish between the abilities of a child with an IQ of 71 and one with an IQ of 69. While the AAMR uses an IQ cutoff of 70, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision (DSM-IV-TR) maintains a cutoff of 71.

In young children, mental impairment is frequently missed by clinicians. Between 2% and 3% of the population has the illness, either as a lone diagnosis or component of a syndrome or other disorder. Both hereditary and environmental variables play a role in the development of mental impairment in children. Despite a thorough evaluation, physicians are unable to pinpoint cause in at least 30% to 50% of instances. A thorough medical history, a thorough physical examination, and a detailed evaluation of the child's development are all essential to making a diagnosis. These will help in determining what kind of assessments and referrals need to be made to ensure the child receives the necessary genetic counselling, family support, and early intervention services. Keeping up with the child's frequent appointments to the family doctor throughout their adolescent and young adulthood is recommended.

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Infants and toddlers often go undiagnosed for mental impairment. Clinicians often make three mistakes that lead them to miss the diagnosis of mental retardation in young patients: (1) concluding that a child does not "look" retarded; (2) assuming that a child who is ambulatory is unlikely to be retarded; and (3) concluding that it is not possible to test young children if retardation is considered.

What Is Intellectual Impairment?

Someone with intellectual disability is restricted in two ways. Some of these are:

• Intellectual functioning: Intelligence quotient, or IQ, describes a person's potential for acquiring knowledge, using logic to solve issues, and forming sound judgements.
• Adaptive behaviours: The ability to take care of oneself, relate positively with others, and communicate effectively are all examples of transferable abilities.

An intelligence quotient (IQ) test is used to do just that (intelligence quotient). The majority of people have an IQ between 85 and 115, with the average being 100. When a person's IQ falls below the 70s or 75s, we classify them as having an intellectual disability.

Specialists can evaluate a child's adaptive behaviours by watching how they use their resources and making comparisons to youngsters of similar ages. The child's ability to feed and dress themselves, his or her ability to speak and understand others, and his or her interactions with adults and peers may all be evaluated.

Roughly one percent of the population may be affected by intellectual impairment. About 85% of people affected are of average intelligence at best. This means that they take a little longer than typical to pick up new information or abilities. Most will be able to function as independently as adults if given the proper resources.

If your kid has an ID, that means their brain didn't fully develop or it was harmed in some way. Neither their intelligence nor their ability to adapt may be typical for the human brain. Formerly, this disorder was referred to as "mental retardation" by the medical community.

There are four levels of ID:

• mild
• moderate
• severe
• profound

Sometimes, ID may be classified as:

• “other”
• “unspecified”

Individuals with ID struggle with both intellectual disability and social adjustment issues. Disabilities in learning, communication, socialisation, or even bodily function are possible as well.

Identification of severe ID at birth is possible. However, if your child has a milder type of ID, you may not suspect anything is wrong until they fail to reach typical milestones in childhood development. When a youngster reaches the age of 18, nearly all cases of ID have been identified.

There is debate not only over how to define MR, but also over how to define specific MR levels. Some people find the word "mental retardation" offensive and derogatory, yet even they admit that any new phrase will quickly acquire the same negative connotations. Some supporters worry that if the terminology is changed, it will influence how people are viewed by the law and treated by the criminal justice system. "Cognitive-adaptive disorders" may replace the current label in the future. However, the term "mental retardation" was kept in the most recent version of Mental Retardation: Definition, Classification, and Support Systems despite great disagreement. (1) Historically, IQ scores have been used to calculate MR levels, with one standard deviation (SD=15 points) representing 15 points below the average IQ of 100. A standard deviation of five points is built into the reported scores because of inherent measurement error and because different instruments have different scoring methodologies.

Classifications of MR as "mild," "moderate," "severe," and "deep" were abandoned by the AAMR definition in 1992, but were kept in the DSM-IV-TR diagnosis from 1994. In 1992, a new method of categorising the seriousness of MR was developed by the AAMR definition: the "Intensity of Needed Levels of Support." The AAMR revised and enlarged the definition of this system in 2002. (1) The strengths of the child, rather than their weaknesses, are still emphasised. Though it's gaining traction in the field, the AAMR system could not correlate well with intelligence when placed in certain out-of-the-ordinary contexts. It has been argued that this technique of classification is not as objective as others for the purposes of evaluating service eligibility and client stratification in research and legal proceedings.

In particular, the DSM-IV-categorization TR's of persons into four groups based on their IQ from mild (50) to severe (75) may be useful in determining the requirements of those in the middle of this range. In this evaluation, those with an IQ of 50 or more are considered to have mild mental retardation, whereas those with an IQ of less than 50 are considered to have severe mental retardation. This threshold is clinically important because those with IQs above 50 appear to profit more from a traditional academic education, while those with IQs below 50 appear to benefit more from a programme that places a premium on the development of practical skills.

Diagnosing Intellectual Disability

Substantial difficulties in both intellectual and adaptive functioning are diagnostic of intellectual disability.

A physician's exam and standardised tests are used to evaluate mental health. Standardized testing is employed for making a diagnosis, even though a certain full-scale IQ test result is not required anymore. If a person's full-scale IQ is between 70 and 75, they have considerable cognitive impairments. 2 However, the IQ must be understood in light of the individual's other cognitive impairments. In addition, there is a wide range of subtest scores, suggesting that the total IQ score may not be indicative of a person's intellectual prowess.

Consideration is given to three aspects of adaptive functioning:

• Conceptual – language, reading, writing, math, reasoning, knowledge, memory
• Social – empathy, social judgment, communication skills, the ability follow the rules and the ability to make and keep friendships
• Practical – independence in areas such as personal care, job responsibilities, managing money, recreation and organising school and work tasks

Standardized measurements are used to evaluate an individual's adaptive functioning, and interviews with others, such as family members, teachers, and carers, are also used to provide more insight about the person's level of support.

To have a modest intellectual disability is defined as The vast majority of those with intellectual disability fall into this bracket, whether mild or severe. Intellectual disability typically presents itself in early childhood or adolescence. By age 2, you may have noticed a delay in verbal or motor development. Nonetheless, a child with a minor intellectual handicap may not show signs of scholastic struggle until they are older and in school.

What Are the Symptoms of Childhood Intellectual Disability?

Many different symptoms in youngsters can indicate intellectual impairment. A youngster may show symptoms as early as infancy or not until they start school. The degree of the disability is often a determining factor. Intellectual disability often manifests itself in the following ways:

• Rolling over, sitting up, crawling, or walking late
• Having problems communicating or starting to communicate late
• Taking a long time to learn new skills, such using the toilet, getting dressed, and feeding himself or herself
• Difficulty remembering things
• Absence of capacity to relate cause and effect
• Behaviour problems such as explosive tantrums
• Impairment in reasoning or problem-solving skills

Children with moderate to severe intellectual disabilities may also experience a variety of physical issues. Seizures, mood disorders (anxiety, autism, etc.), impaired motor abilities, vision impairments, and hearing loss are all possible outcomes of these conditions.

Intellectual Disability Symptoms

Depending on the severity of your child's handicap, you may notice ID symptoms such as:

• inability to reach a certain level of intellectual development
• later than average onset of sitting, crawling, or walking
• issue communicating effectively or difficulty learning to talk
• memory problems
• failing to grasp how one's actions will affect others
• inability to think logically
• childish behaviour inconsistent with the child’s age
• lack of curiosity
• learning difficulties
• IQ below 70
• difficulties that prevent you from living alone expressing themselves, looking after themselves, or interacting socially

Behavioural concerns your kid might have if they have an ID include the following:

• aggression
• dependency
• withdrawal from social activities
• attention-seeking behaviour
• depression during adolescent and teen years
• lack of impulse control
• passivity
• tendency toward self-injury
• stubbornness
• low self-esteem
• low tolerance for frustration
• psychotic disorders
• difficulty paying attention

Persons with ID could also share common physical traits. Among these are things like a lack of height or a distorted face.

Levels of Intellectual Disability

Based on your child's IQ and level of social adjustment, ID can be classified into one of four categories.

Mild Intellectual Disability

Mild intellectual disability can manifest in a variety of ways:

• slower to pick up language skills, but strong communicators once they do
• being able to take care of themselves without assistance as they age
• unable to read and write properly
• social immaturity
• a rise in stress due to the demands of marriage or parenthood
• benefiting from specialised education plans
• having an IQ range of 50 to 69

Moderate Intellectual Disability

Some or all of the following symptoms might be present in your child with moderate ID:

• are slow to comprehend and use language
• may encounter communication difficulties
• can learn the fundamentals of reading, writing, and counting
• are generally unable to live on their own
• can frequently travel to familiar locations on their own
• can participate in a variety of social activities
• generally having an IQ range of 35 to 49

Severe Intellectual Disability

Symptoms of severe ID include:

• visible motor impairment
• severe damage to or abnormal development of their central nervous system
• generally having an IQ range of 20 to 34

Profound Intellectual Disability

Symptoms of profound ID include:

• inability to comprehend or follow requests or instructions
• possible immobility
• incontinence
• basic nonverbal communication
• incapacity to meet their own needs without assistance
• the need for constant help and supervision
• having an IQ of less than 20

Other intellectual disability

People that fall within this group typically have some form of physical impairment, such as deafness, mutism, or an inability to speak. Your child's physician may be unable to perform screening procedures due to these concerns.

Unspecified intellectual disability

Your child may exhibit ID symptoms if they have an unidentified ID, but your doctor will lack the context necessary to assess your child's level of impairment.

Related and co-occurring conditions

Individuals with intellectual disability frequently have comorbidity between mental health, neurodevelopmental, medical, and physical illnesses such as cerebral palsy, epilepsy, attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and depression and anxiety. It may be difficult to recognise depression in a person with poor linguistic skills and to diagnose a co-occurring disease when there is one. However, in order to live a healthy and productive life, a correct treatment and diagnosis are essential.

• Attention-deficit/hyperactivity disorder
• Autism spectrum disorder
• Social communication disorder
• Specific learning disorder

Advice for Parents

• Find out more about your child's disability.
• Share your experiences as a parent of a disabled child with others.
• Be patient; your child's learning may take longer.
• Encourage self-reliance and accountability.
• Look for social, recreational, and sporting opportunities in your community.

How Is Intellectual Disability Diagnosed?

An ID diagnosis requires cognitive and social impairments beyond the norm. The doctor will check three things when examining your child:

• interviews with you
• observations of your child
• standard tests

The Stanford-Binet Intelligence Scale and similar tests will be used to evaluate your child's mental capacity. The doctor can use this information to calculate your child's intelligence using this method.

The Vineland Adaptive Behavior Scales are one example of additional tests that the doctor might use. Your child's social and daily-living skills will be evaluated in comparison to other children of the same age using this test.

It's possible that kids from different backgrounds and socioeconomic levels would have varied exam scores. The doctor will evaluate the test results, talk to you and your kid, and use their clinical judgement to arrive at a diagnosis.

It's possible that your child will see a variety of specialists, such as those listed below, as part of the evaluation process.

• psychologist
• speech pathologist
• social worker
• pediatric neurologist
• developmental pediatrician
• physical therapist

Imaging and laboratory tests could also be administered. The doctor can use these to spot metabolic and genetic diseases, as well as brain structure issues, in the young patient.

In addition to genetic factors, hearing loss, learning issues, neurological abnormalities, and emotional problems can all contribute to a child's slow growth and development. If your child's doctor suspects ID, he or she should first rule out these possibilities.

The results of these assessments will be used by your child's doctor, school, and you to formulate a plan for your child's care and education.

Options for Treating Intellectual Disability

Because of your child's impairment, they will likely require regular therapy sessions.

A family service plan detailing your child's need will be provided to you. Your child's plan will also specify the services they need to thrive. The demands of your loved ones will also be taken into consideration.

When your kid is old enough to start school, an IEP will be created to meet his or her specific educational requirements. It is important to provide children with disabilities access to special education.

Public schools are obligated under the Individuals with Disabilities Education Act (IDEA) to educate students who have intellectual disabilities or other forms of developmental disability at no cost to the family.

Treatment is aimed at helping your child achieve his or her full potential in the following areas:

• education
• social skills
• life skills

Treatment may include:

• behaviour therapy
• occupational therapy
• counselling
• medication, in some cases

What Is the Long-term Outlook?

Your child's life expectancy may be lower than typical if ID coexists with other major physical issues. If your child's ID is mild to moderate, however, they should live a typical lifespan.

Your child may be able to find a job suitable to their level of ID, become financially self-sufficient, and contribute to society once they reach adulthood.

There are programmes available to adults with ID to assist them maintain their independence and pursue their life goals.

The likelihood that the patient's mental impairment will be passed on to subsequent siblings or other relatives is conditional on the precise diagnosis. Although a general consultation with a geneticist may be helpful, a geneticist cannot provide the family with the recurrence risk for mental retardation without first making a diagnosis. The primary care physician can be an invaluable asset in monitoring the family's risk of recurrence.

Special somatic growth charts and practise recommendations for primary care of children with specific conditions (such as Down syndrome and fragile X syndrome) are also available. There are additional lists of online resources that may be useful to the family doctor, such as recommendations for the management of persons with mental retardation who have been deinstitutionalized.

It is important for doctors to keep in mind that their young patients with mental retardation or developmental disorders will grow up fast. Most teenagers and young adults will require assistance from professionals to learn to be effective advocates for themselves as they navigate the healthcare system. It's important for families to have moral and practical backing as they push their teenager or early adult child towards greater autonomy. Important but outside the focus of this essay are questions of sexuality, family planning, custodial care, estate planning, and guardianship.