Sunday, 7 December 2014

 

Intellectual disability

From Wikipedia, the free encyclopedia


Cretin Child In Bhutan
See also: Developmental disability
Intellectual disability
Classification and external resources
ICD-10F70-F79
ICD-9317-319
DiseasesDB4509
MedlinePlus001523
eMedicinemed/3095 neuro/605
MeSHD008607
Intellectual disability (ID), also called intellectual development disorder (IDD) and formerly known as mental retardation (MR),[1][2][3] is aneurodevelopmental disorder characterized by impaired intellectual andadaptive functioning which is defined by an IQ score below 70 as well as a delay in general daily living skills. Other common symptoms include speech delays and lack of social functioning. Down syndrome and Fragile X syndromeoften overlap with ID.
The terms used for this condition are subject to a process called theeuphemism treadmill. This means that whatever term is chosen for this condition, it eventually becomes perceived as an insult. The terms mental retardation and mentally retarded were invented in the middle of the 20th century to replace the previous set of terms, which were deemed to have become offensive. By the end of the 20th century, these terms themselves have come to be widely seen as disparaging, politically incorrect, and in need of replacement.[4] The term intellectual disability is now preferred by most advocates and researchers in most English-speaking countries.[2][3] As of 2013, the term "mental retardation" is still used by the World Health Organization in the ICD-10 codes, which have a section titled "Mental Retardation" (codes F70–F79). In the next revision, the ICD-11 is expected to replace the term "mental retardation" with "intellectual disability," and the DSM-5 has replaced it with "intellectual developmental disorder."[5][6] Because of its specificity and lack of confusion with other conditions, the term "mental retardation" is still sometimes used in professional medical settings around the world, such as formal scientific research and health insurance paperwork.[7]

Signs and symptoms

The signs and symptoms of intellectual disability are all behavioral. Most people with intellectual disability do not look like they are afflicted with such, especially if the disability is caused by environmental factors such as malnutrition or lead poisoning. The so-called typical appearance ascribed to people with intellectual disability is only present in a minority of cases, all of which are syndromic.
Children with intellectual disability may learn to sit up, to crawl, or to walk later than other children, or they may learn to talk later.[8] Both adults and children with intellectual disability may also exhibit some or all of the following characteristics:[8]
Children with intellectual disability learn more slowly than a typical child. Children may take longer to learn language, develop social skills, and take care of their personal needs, such as dressing or eating. Learning will take them longer, require more repetition, and skills may need to be adapted to their learning levels. Nevertheless, virtually every child is able to learn, develop and become a participating member of the community.
In early childhood, mild intellectual disability (IQ 50–69) may not be obvious, and may not be identified until children begin school.[8] Even when poor academic performance is recognized, it may take expert assessment to distinguish mild intellectual disability from learning disability or emotional/behavioral disorders. People with mild intellectual disability are capable of learning reading and mathematics skills to approximately the level of a typical child aged nine to twelve.[8] They can learn self-care and practical skills, such as cooking or using the local mass transit system.[8] As individuals with intellectual disability reach adulthood, many learn to live independently and maintain gainful employment.
Moderate intellectual disability (IQ 35–49) is nearly always apparent within the first years of life. Speech delays are particularly common signs of moderate MR.[8] People with moderate intellectual disability need considerable supports in school, at home, and in the community in order to participate fully. While their academic potential is limited, they can learn simple health and safety skills and to participate in simple activities.[8] As adults they may live with their parents, in a supportive group home, or even semi-independently with significant supportive services to help them, for example, manage their finances. As adults, they may work in a sheltered workshop.[8]
People with severe or profound intellectual disability need more intensive support and supervision their entire lives.[8] They may learn some activities of daily living. Some require full-time care by an attendant.[8]

Cause

Further information: X-linked intellectual disability
Among children, the cause is unknown for one-third to one-half of cases.[8] Down syndrome, velocariofacial syndrome, andfetal alcohol syndrome are the three most common inborn causes.[8] However, doctors have found many other causes. The most common are:

Diagnosis

According to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV),[15] three criteria must be met for a diagnosis of intellectual disability: an IQ below 70, significant limitations in two or more areas of adaptive behavior (as measured by an adaptive behavior rating scale, i.e. communication, self-help skills, interpersonal skills, and more), and evidence that the limitations became apparent before the age of 18.
It is formally diagnosed by an assessment of IQ and adaptive behavior. A third condition requiring onset in childhood is used to distinguish intellectual disability from dementia such as Alzheimer's disease or due to traumatic brain injuries.

Intelligence quotient

The first English-language IQ test, the Stanford-Binet Intelligence Scales, was adapted from a test battery designed for school placement by Alfred Binet in France. Lewis Terman adapted Binet's test and promoted it as a test measuring "general intelligence." Terman's test was the first widely used mental test to report scores in "intelligence quotient" form ("mental age" divided by chronological age, multiplied by 100). Current tests are scored in "deviation IQ" form, with a performance level by a test-taker two standard deviations below the median score for the test-taker's age group defined as IQ 70. Until the most recent revision of diagnostic standards, an IQ of 70 or below was a primary factor for intellectual disability diagnosis, and IQ scores were used to categorize degrees of intellectual disability.
Since current diagnosis of intellectual disability is not based on IQ scores alone, but must also take into consideration a person's adaptive functioning, the diagnosis is not made rigidly. It encompasses intellectual scores, adaptive functioning scores from an adaptive behavior rating scale based on descriptions of known abilities provided by someone familiar with the person, and also the observations of the assessment examiner who is able to find out directly from the person what he or she can understand, communicate, and such like. IQ assessment must be based on a current test. This enables diagnosis to avoid the pitfall of the Flynn Effect, which is a consequence of changes in population IQ test performance changing IQ test norms over time.

Distinction from other disabilities

Clinically, intellectual disability is a subtype of cognitive deficit or disabilities affecting intellectual abilities, which is a broader concept and includes intellectual deficits that are too mild to properly qualify as intellectual disability, or too specific (as inspecific learning disability), or acquired later in life through acquired brain injuries or neurodegenerative diseases likedementia. Cognitive deficits may appear at any age. Developmental disability is any disability that is due to problems withgrowth and development. This term encompasses many congenital medical conditions that have no mental or intellectual components, although it, too, is sometimes used as a euphemism for intellectual disability.[16]

Limitations in more than one areas

Adaptive behavior, or adaptive functioning, refers to the skills needed to live independently (or at the minimally acceptable level for age). To assess adaptive behavior, professionals compare the functional abilities of a child to those of other children of similar age. To measure adaptive behavior, professionals use structured interviews, with which they systematically elicit information about persons' functioning in the community from people who know them well. There are many adaptive behavior scales, and accurate assessment of the quality of someone's adaptive behavior requires clinical judgment as well. Certain skills are important to adaptive behavior, such as:

Management

By most definitions intellectual disability is more accurately considered a disability rather than a disease. Intellectual disability can be distinguished in many ways from mental illness, such as schizophrenia or depression. Currently, there is no "cure" for an established disability, though with appropriate support and teaching, most individuals can learn to do many things.
There are thousands of agencies around the world that provide assistance for people with developmental disabilities. They include state-run, for-profit, and non-profit, privately run agencies. Within one agency there could be departments that include fully staffed residential homes, day rehabilitation programs that approximate schools, workshops wherein people with disabilities can obtain jobs, programs that assist people with developmental disabilities in obtaining jobs in the community, programs that provide support for people with developmental disabilities who have their own apartments, programs that assist them with raising their children, and many more. There are also many agencies and programs for parents of children with developmental disabilities.
Beyond that there are specific programs that people with developmental disabilities can take part in wherein they learn basic life skills. These "goals" may take a much longer amount of time for them to accomplish, but the ultimate goal is independence. This may be anything from independence in tooth brushing to an independent residence. People with developmental disabilities learn throughout their lives and can obtain many new skills even late in life with the help of their families, caregivers, clinicians and the people who coordinate the efforts of all of these people.
There are four broad areas of intervention that allow for active participation from caregivers, community members, clinicians, and of course, the individual(s) with an intellectual disability. These include psychosocial treatments, behavioral treatments, cognitive-behavioral treatments, and family-oriented strategies [17] Psychosocial treatments are intended primarily for children before and during the preschool years as this is the optimum time for intervention.[18] This early intervention should include encouragement of exploration, mentoring in basic skills, celebration of developmental advances, guided rehearsal and extension of newly acquired skills, protection from harmful displays of disapproval, teasing, or punishment, and exposure to a rich and responsive language environment.[19] A great example of a successful intervention is the Carolina Abecedarian Project that was conducted with over 100 children from low SES families beginning in infancy through pre-school years. Results indicated that by age 2, the children provided the intervention had higher test scores than control group children, and they remained approximately 5 points higher 10 years after the end of the program. By young adulthood, children from the intervention group had better educational attainment, employment opportunities, and fewer behavioral problems than their control-group counterparts.[20]
Core components of behavioral treatments include language and social skills acquisition. Typically, one-to-one training is offered in which a therapist uses a shaping procedure in combination with positive reinforcements to help the child pronounce syllables until words are completed. Sometimes involving pictures and visual aids, therapists aim at improving speech capacity so that short sentences about important daily tasks (e.g. bathroom use, eating, etc.) can be effectively communicated by the child.[21][22] In a similar fashion, older children benefit from this type of training as they learn to sharpen their social skills such as sharing, taking turns, following instruction, and smiling.[23] At the same time, a movement known as social inclusion attempts to increase valuable interactions between children with an intellectual disability and their non-disabled peers. [24] Cognitive-behavioral treatments, a combination of the previous two treatment types, involves astrategical-metastrategical learning technique[clarification needed] that teaches children math, language, and other basic skills pertaining to memory and learning. The first goal of the training is to teach the child to be a strategical thinker through making cognitive connections and plans. Then, the therapist teaches the child to be metastrategical by teaching them to discriminate among different tasks and determine which plan or strategy suits each task.[25] Finally, family-oriented strategies delve into empowering the family with the skill set they need to support and encourage their child or children with an intellectual disability. In general, this includes teaching assertiveness skills or behavior management techniques as well as how to ask for help from neighbors, extended family, or day-care staff.[26] As the child ages, parents are then taught how to approach topics such as housing/residential care, employment, and relationships. The ultimate goal for every intervention or technique is to give the child autonomy and a sense of independence using the acquired skills he/she has.
Although there is no specific medication for intellectual disability, many people with developmental disabilities have further medical complications and may be prescribed several medications. For example autistic children with developmental delay may be prescribed antipsychotics or mood stabilizers to help with their behavior. Use of psychotropic medications such asbenzodiazepines in people with intellectual disability requires monitoring and vigilance as side effects occur commonly and are often misdiagnosed as behavioral and psychiatric problems.[27]

Epidemiology

Intellectual disability affects about 2–3 percent of the general population.[8] 75–90% of the affected people have mild intellectual disability .[8]
Non-syndromic or idiopathic ID accounts for 30–50 percent of cases.[8] About a quarter of cases are caused by a genetic disorder.[8]

History

Intellectual disabilities of all kinds have been documented under a variety of names throughout history. Throughout much of human history, society was unkind to those with any type of disability, and people with intellectual disabilities were commonly viewed as burdens on their families.
Greek and Roman philosophers, who valued reasoning abilities, disparaged people with intellectual disabilities as barely human.[28] The oldest physiological view of intellectual disability is in the writings of Hippocrates in the late fifth century BCE, who believed that it was caused by an imbalance in the four humors in the brain.
Until the Enlightenment in Europe, care and asylum was provided by families and the church (in monasteries and other religious communities), focusing on the provision of basic physical needs such as food, shelter and clothing. Negative stereotypes were prominent in social attitudes of the time.
In the 13th century, England declared people with intellectual disabilities to be incapable of making decisions or managing their affairs.[28] Guardianships were created to take over their financial affairs.
In the 17th century, Thomas Willis provided the first description of intellectual disabilities as a disease.[28] He believed that it was caused by structural problems in the brain. According to Willis, the anatomical problems could be either an inborn condition or acquired later in life.
In the 18th and 19th centuries, housing and care moved away from families and towards an asylum model. People were placed by, or removed from, their families (usually in infancy) and housed in large professional institutions, many of which were self-sufficient through the labor of the residents. Some of these institutions provided a very basic level of education (such as differentiation between colors and basic word recognition and numeracy), but most continued to focus solely on the provision of basic needs of food, clothing, and shelter. Conditions in such institutions varied widely, but the support provided was generally non-individualized, with aberrant behavior and low levels of economic productivity regarded as a burden to society. Individuals of higher wealth were often able to afford higher degrees of care such as home care or private asylums.[29] Heavy tranquilization and assembly line methods of support were the norm, and the medical model of disability prevailed. Services were provided based on the relative ease to the provider, not based on the needs of the individual. A survey taken in 1891 in Cape Town, South Africa shows the distribution between different facilities. Out of 2046 persons surveryed, 1,281 were in private dwellings, 120 in jails, and 645 in asylums, with men representing nearly two thirds of the number surveyed. In situations of scarcity of accommodation, preference was given to white men and black men (whose insanity threatened white society by disrupting employment relations and the tabooed sexual contact with white women).[29]
In the late 19th century, in response to Charles Darwin's On the Origin of Species, Francis Galton proposed selective breeding of humans to reduce intellectual disabilities.[28] Early in the 20th century the eugenics movement became popular throughout the world. This led to forced sterilization and prohibition of marriage in most of the developed world and was later used by Hitler as rationale for the mass murder of intellectually challenged individuals during the holocaust. Eugenics was later abandoned as an evil violation of human rights, and the practice of forced sterilization and prohibition from marriage was discontinued by most of the developed world by the mid-20th century.
In 1905, Alfred Binet produced the first standardized test for measuring intelligence in children.[28]
Although ancient Roman law had declared people with intellectual disability to be incapable of the deliberate intent to harmthat was necessary for a person to commit a crime, during the 1920s, Western society believed they were morally degenerate.[28]
Ignoring the prevailing attitude, Civitans adopted service to the developmentally disabled as a major organizational emphasis in 1952. Their earliest efforts included workshops for special education teachers and daycamps for disabled children, all at a time when such training and programs were almost nonexistent.[30] The segregation of people with developmental disabilities wasn't widely questioned by academics or policy-makers until the 1969 publication of Wolf Wolfensberger's seminal work "The Origin and Nature of Our Institutional Models",[31] drawing on some of the ideas proposed by SG Howe 100 years earlier. This book posited that society characterizes people with disabilities as deviant, sub-human and burdens of charity, resulting in the adoption of that "deviant" role. Wolfensberger argued that this dehumanization, and the segregated institutions that result from it, ignored the potential productive contributions that all people can make to society. He pushed for a shift in policy and practice that recognized the human needs of those with intellectual disability and provided the same basic human rights as for the rest of the population.
The publication of this book may be regarded as the first move towards the widespread adoption of the social model of disability in regard to these types of disabilities, and was the impetus for the development of government strategies for desegregation. Successful lawsuits against governments and an increasing awareness of human rights and self-advocacy also contributed to this process, resulting in the passing in the U.S. of the Civil Rights of Institutionalized Persons Act in 1980.
From the 1960s to the present, most states have moved towards the elimination of segregated institutions. Normalizationand deinstitutionalization are dominant.[28] Along with the work of Wolfensberger and others including Gunnar and Rosemary Dybwad,[32] a number of scandalous revelations around the horrific conditions within state institutions created public outrage that led to change to a more community-based method of providing services.[33]
By the mid-1970s, most governments had committed to de-institutionalization, and had started preparing for the wholesale movement of people into the general community, in line with the principles of normalization. In most countries, this was essentially complete by the late 1990s, although the debate over whether or not to close institutions persists in some states, including Massachusetts.[34]
In the past, lead poisoning and infectious diseases were significant causes of intellectual disabilities. Some causes of intellectual disability are decreasing, as medical advances, such as vaccination, increase. Other causes are increasing as a proportion of cases, perhaps due to rising maternal age, which is associated with several syndromic forms of intellectual disability.[citation needed]
Along with the changes in terminology, and the downward drift in acceptability of the old terms, institutions of all kinds have had to repeatedly change their names. This affects the names of schools, hospitals, societies, government departments, and academic journals. For example, the Midlands Institute of Mental Subnormality became the British Institute of Mental Handicap and is now the British Institute of Learning Disability. This phenomenon is shared with mental health and motor disabilities, and seen to a lesser degree in sensory disabilities.[citation needed]

Terminology

Terms that denote mental deficiency have been subjected to the euphemism treadmill. The several traditional terms that long predate psychiatry are simple forms of abuse in common usage today; they are often encountered in such old documents as books, academic papers, and census forms (for example, the British census of 1901 has a column heading including the terms imbecile and feeble-minded).
Negative connotations associated with these numerous terms for intellectual disability reflect society's attitude about the condition. Some elements of society seek neutral medical terms, while others want to use such terms as weapons of abuse.
Today, new words like special or challenged are replacing the term retarded. The term developmental delay is popular among caretakers and parents of individuals with intellectual disability because delay suggests that a person is slowly reaching his or her full potential rather than being disabled.[citation needed]
Usage has changed over the years and differed from country to country. For example, mental retardation in some contexts covers the whole field but previously applied to what is now the mild MR group. Feeble-minded used to mean mild MR in the UK, and once applied in the US to the whole field. "Borderline intellectual functioning" is not currently defined, but the term may be used to apply to people with IQs in the 70s. People with IQs of 70 to 85 used to be eligible for special consideration in the US public education system on grounds of intellectual disability.[citation needed]
  • Cretin is the oldest and comes from a dialectal French word for Christian.[35] The implication was that people with significant intellectual or developmental disabilities were "still human" (or "still Christian") and deserved to be treated with basic human dignity. Individuals with the condition were considered to be incapable of sinning, thus "christ-like" in their disposition. This term is not used in scientific endeavors since the middle of the 20th century and is generally considered a term of abuse. Although cretin is no longer in use, the term cretinism is still used to refer to the mental and physical disability resulting from untreated congenital hypothyroidism.
  • Amentia has a long history, mostly associated with dementia. The difference between amentia and dementia was originally defined by time of onset. Amentia was the term used to denote an individual who developed deficits in mental functioning early in life, while dementia included individuals who develop mental deficiencies as adults. During the 1890s, amentia meant someone who was born with mental deficiencies. By 1912, ament was a classification lumping "idiots, imbeciles, and feeble minded" individuals in a category separate from a dement classification, in which the onset is later in life.
  • Idiot indicated the greatest degree of intellectual disability, where the mental age is two years or less, and the person cannot guard himself or herself against common physical dangers. The term was gradually replaced by the termprofound mental retardation (which has itself since been replaced by other terms).
  • Imbecile indicated an intellectual disability less extreme than idiocy and not necessarily inherited. It is now usually subdivided into two categories, known as severe intellectual disability and moderate intellectual disability.
  • Moron was defined by the American Association for the Study of the Feeble-minded in 1910, following work by Henry H. Goddard, as the term for an adult with a mental age between eight and twelve; mild intellectual disability is now the term for this condition. Alternative definitions of these terms based on IQ were also used. This group was known in UK law from 1911 to 1959/60 as feeble-minded.
  • Mongolism was a medical term used to identify someone with Down syndrome. The Mongolian People's Republicrequested that the medical community cease use of the term as a referent to intellectual disability. Their request was granted in the 1960s, when the World Health Organization agreed that the term should cease being used within the medical community.
  • In the field of special education, educable (or "educable intellectual disability") refers to ID students with IQs of approximately 50–75 who can progress academically to a late elementary level. Trainable (or "trainable intellectual disability") refers to students whose IQs fall below 50 but who are still capable of learning personal hygiene and other living skills in a sheltered setting, such as a group home. In many areas, these terms have been replaced by use of "moderate" and "severe" intellectual disability. While the names change, the meaning stays roughly the same in practice.
  • Retarded comes from the Latin retardare, "to make slow, delay, keep back, or hinder," so mental retardation meant the same as mentally delayed. The term was recorded in 1426 as a "fact or action of making slower in movement or time." The first record of retarded in relation to being mentally slow was in 1895. The term retarded was used to replace terms like idiot, moron, and imbecile because retarded was not then a derogatory term. By the 1960s, however, the term had taken on a partially derogatory meaning as well. The noun retard is particularly seen as pejorative; as of 2010, theSpecial Olympics, Best Buddies and over 100 other organizations are striving to eliminate the use of the "r-word" (analogous to the "n-word") in everyday conversation.[36][37]
    The term mental retardation was a diagnostic term denoting the group of disconnected categories of mental functioning such as idiot, imbecile, and moron derived from early IQ tests, which acquired pejorative connotations in popular discourse. The term mental retardation acquired negative and shameful connotations over the last few decades due to the use of the words retarded and retard as insults. This may have contributed to its replacement with euphemisms such as mentally challenged or intellectually disabled. While developmental disability includes many other disorders (see below), developmental disability and developmental delay (for people under the age of 18), are generally considered more polite terms than mental retardation.

United States

  • In North America intellectual disability is subsumed into the broader term developmental disability, which also includesepilepsy, autism, cerebral palsy and other disorders that develop during the developmental period (birth to age 18). Because service provision is tied to the designation 'developmental disability', it is used by many parents, direct support professionals, and physicians. In the United States, however, in school-based settings, the more specific term mental retardation or, more recently (and preferably), intellectual disability, is still typically used, and is one of 13 categories of disability under which children may be identified for special education services under Public Law 108-446.
  • The phrase intellectual disability is increasingly being used as a synonym for people with significantly below-average cognitive ability. These terms are sometimes used as a means of separating general intellectual limitations from specific, limited deficits as well as indicating that it is not an emotional or psychological disability. Intellectual disabilitymay also refer to the outcome of traumatic brain injury, lead poisoning, or dementing conditions such as Alzheimer's disease. It is not specific to congenital disorders such as Down syndrome.
The "American Association on Mental Retardation" continued to use the term mental retardation until 2006.[38] In June 2006 its members voted to change the name of the organization to the "American Association on Intellectual and Developmental Disabilities," rejecting the options to become the AAID or AADD. Part of the rationale for the double name was that many members worked with people with pervasive developmental disorders, most of whom do not have intellectual disability.[39]

United Kingdom

In the UK, mental handicap had become the common medical term, replacing mental subnormality in Scotland and mental deficiency in England and Wales, until Stephen Dorrell, Secretary of State for Health for the United Kingdom from 1995–97, changed the NHS's designation to learning disability.[40] The new term is not yet widely understood, and is often taken to refer to problems affecting schoolwork (the American usage), which are known in the UK as "learning difficulties." Britishsocial workers may use "learning difficulty" to refer to both people with intellectual disability and those with conditions such as dyslexia.[41] In education, "learning difficulties" is applied to a wide range of conditions: "specific learning difficulty" may refer to dyslexia, dyscalculia or developmental coordination disorder, while "moderate learning difficulties", "severe learning difficulties" and "profound learning difficulties" refer to more significant impairments.[42][43]
In England and Wales between 1983 and 2008 the Mental Health Act 1983 defined "mental impairment" and "severe mental impairment" as "...a state of arrested or incomplete development of mind which includes significant/severe impairment of intelligence and social functioning and is associated with abnormally aggressive or seriously irresponsible conduct on the part of the person concerned."[44] As behavior was involved, these were not necessarily permanent conditions: they were defined for the purpose of authorizing detention in hospital or guardianship. The term mental impairment was removed from the Act in November 2008, but the grounds for detention remained. However, English statute law uses mental impairment elsewhere in a less well-defined manner—e.g. to allow exemption from taxes—implying that intellectual disability without any behavioral problems is what is meant.
A BBC poll conducted in the United Kingdom came to the conclusion that 'retard' was the most offensive disability-related word.[45] On the reverse side of that, when a contestant on Celebrity Big Brother live used the phrase "walking like a retard", despite complaints from the public and the charity Mencap, the communications regulator Ofcom did not uphold the complaint saying "it was not used in an offensive context [...] and had been used light-heartedly". It was however noted that two previous similar complaints from other shows were upheld.[46]

Australia

In the past, Australia has used British and American terms interchangeably, including "mental retardation" and "mental handicap". Today, "intellectual disability" is the preferred and more commonly used descriptor.[47]

Society and culture


Severely disabled girl in Bhutan
People with such disabilities are often not seen as full citizens of society. Person-centered planning and approaches are seen as methods of addressing the continued labeling and exclusion of socially devalued people, such as people with disabilities, encouraging a focus on the person as someone with capacities and gifts as well as support needs. The self-advocacy movement promotes the right of self-determination and self-direction by people with intellectual disabilities, which means allowing people with intellectual disabilities to make decisions about their own lives.
Until the middle of the 20th century, people with intellectual disabilities were routinely excluded from public education, or educated away from other typically developing children. Compared to students with intellectual disabilities who were segregated in special schools, students with intellectual disabilities who are mainstreamed or included in regular classrooms report similar levels of stigma and social self-conception, but more ambitious plans for employment.[48]
As adults, people with intellectual disabilities may live independently, with family members, or in different types of institutions organized to support people with intellectual disabilities. About 8% of people with intellectual disability live in an institution orgroup home.[49]
In the US, the average lifetime cost of intellectual disability amounts to $1,014,000 per person with intellectual disability, in 2003 US dollars.[49] This is slightly more than the costs associated with cerebral palsy, and double that associated with serious vision or hearing impairments. Of that $1,014,000, about 14% is due to increased medical expenses (not including what is normally incurred by the typical person), 10% is due to direct non-medical expenses, such as the excess cost ofspecial education compared to standard schooling, and 76% is indirect costs accounting for reduced productivity and shortened lifespans. Some expenses, such as costs associated with being a family caregiver or living in a group home, were excluded from this calculation.[49]
Abusive terms for intellectual deficits are common insults, and are most commonly applied to non-disabled people. For example, in the 1964 movie Becket, King Henry II calls his son and heir a "cretin". Mental health professionals discourage use of these terms. The abbreviation retard or tard is still used as a generic insult. A BBC survey in 2003 ranked retard as the most offensive disability-related word, ahead of terms such as spastic (or its abbreviation spaz) and mong.[50] A campaign led by people with intellectual disabilities and the Special Olympics to eliminate the word retard has resulted in federal legislation to replace the term mentally retarded with the term intellectual disability in some federal statutes.[51]

Health disparities

People with intellectual disabilities as a group have higher rates of adverse health conditions such as epilepsy and neurological disorders, gastrointestinal disorders and behavioral/psychiatric problems compared to people without disabilities.[52] Adults with intellectual disability have also higher prevalence of poor social determinants of health, behavioral risk factors, depression, diabetes, poor or fair health status than adults without intellectual disability.[53]

See also


NAGPUR: Children who are mentally challenged are taken better care of by their parents and teachers today than a few years ago. However, the society and the government have still not been able to play their part in improving the lives of such children, believe parents and doctors.

On the occasion of World Mental Retardation Day, parents of children suffering from the affliction will be handing over a list of demands to the Nagpur Municipal Corporation (NMC) on Monday. The rights of children with special needs have been highlighted throughout the current year. The biggest concern for these parents remains what would happen to their children after the parents themselves are not around any more.

"Several countries have arrangements made by the governments for mentally challenged people where they can live and be taken good care of. This kind of arrangement must be started in India as well. In the absence of this, private organizations often begin things on a smaller level but they face severe crunch of resources," said Dr Ravindra Gokhale, former president and adviser Sweekar, a city-based organization of parents of children with special needs and Parivar Sahyadri, a similar state-level association.

Members of Sweekar have been pooling in resources for the last 10 years with the aim of making such an arrangement for special children in the city. They have finally got hold of a piece of land where this prospective home will come up.

Another big concern for parents is independence of these children. "While schools and non-governmental organizations provide children the necessary vocational training, the skills acquired are often wasted as no organized way of utilizing it exists," pointed out Dr Gokhale.

Paediatric physiotherapist Dr Meenakshi Wankhede, who works for the rehabilitation of several children with developmental disorders, has been trying for couple of years to make available gardens for children with special needs. "I have been told a garden meant only for a specific group of children may not be plausible. However, it would be a better idea to have at least parts of regular gardens designed to be used for special children. This way the other children would also understand the needs of special children and take care of them. This lesson in an early age is sure to make the society as a whole more sensitive to the needs of people with developmental disabilities in the future," she said.

She is an advocate of utilizing computers for the education as well as employment of these children. "Several discussions of the Indian Academy of Cerebral Palsy point out how technology can provide these kids the right to live with dignity," she said.

An executive member of both Sweekar and Sahyadri Parivaar Abhay Dive conducts workshops for the mentally challenged kids where they interact among themselves without the help of parents. "From what the children tell me, I feel they want to be self dependent and have some job security. They believe that the society should be more confident about their talents and skills. Also, they are often subjected to physical abuse and bullying when away from their family," he said.

Dive said that the perception that these kids are not worldly wise and aware is faulty. "Looking at the way they discuss important issues, I believe they must also be given the right to vote as citizens, may be at 25 rather than 18, like us 'normal' people," he said.


DEMANDS OF PARENTS' ASSOCIATION

Register all kids with developmental disorders.

Organize district-level sports competition, annual picnic and other activities, giving children and parents a platform to interact with each other.

Float employment schemes for the kids, open sales counter for the artefacts kids make in workshops

Make arrangements of health policies for the mentally challenged people

NMC should help spread awareness about such conditions


MEASURES TO IMPROVE LIVES

Starting shelter and care centres

Let them participate in public life as voters and in other roles

Make public places and society more suited for them

Take help of relevant technological advances

Take steps to curb physical abuse and bullying
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