Clinical Reference Systems: Pediatric Advisor 10.0

Mental retardation (MR) means a person has significantly below average intelligence. A person who is retarded cannot easily change his behavior in response to certain situations or demands.

There are four levels of MR: mild, moderate, severe, and profound. These levels are measured using a standard psychological test.

What is the cause?

Many medical conditions have been associated with MR including:

• abnormal brain development before birth
• infections a pregnant mother has such as German measles
• severe oxygen deficiency at birth
• metabolic diseases
• chromosome abnormalities (Down syndrome and fragile X syndrome)
• meningitis.

For most children, however, the exact cause of MR is never found.

If you suspect your child has MR, your doctor will want to search for the cause. He or she may discover a disorder that requires special medical care or a problem that may be genetic and should be considered in future pregnancies.

What kind of testing will my child have?

It is difficult to figure out the degree of mental retardation or predict how a child will develop over time.

Developmental tests are used to measure how well your child is doing compared to other children of the same age. If your child's functional (intellectual) age is a lot lower than the your child's age in months or years, then your child is probably mentally retarded.

In the preschool and school-age years, your child can have an IQ, or intelligence quotient, test done. The IQ test can show the degree of mental retardation. The IQ test helps predict how well your child will do academically and socially. Your physician or other specialists will figure out which tests are best for your child.

How will my child develop?

Most children with MR will learn new things but at a slower pace than normal. You should give a child with MR opportunities to learn.

Your child's ability to function mentally, physically, and emotionally depends on the severity of the retardation. The following levels of retardation, based on IQ, are estimates of how well a person with MR will be able to function as a child and as an adult.

Mild Retardation (approximate IQ range 55 to 69): Preschool-age children with mild MR are often not noticed as retarded by most people, but they are slower than most children to walk, feed themselves, and talk. Mildly retarded children, when given special education, can learn practical skills and useful reading and math to a 3rd- to 6th-grade level. As adults, they can usually achieve social and job skills and live by themselves. However, they may need some guidance and support during times of unusual social or economic stress.

Moderate Retardation (approximate IQ range 40 to 54): Moderately retarded preschool-age children show noticeable delays in development of motor skills and speech. Older children can learn simple communication, elementary health and safety habits, and simple skills. They are not able to gain reading or math skills. As adults, they can do simple tasks under special conditions and can travel alone in familiar places. They usually cannot live totally independently.

Severe Retardation (approximate IQ range 25 to 39): Severely retarded preschool-age children have delays in motor development and little or no communication skills. With training, the children may be able to learn some basic self-help skills, such as feeding themselves and bathing. As they grow older they can usually walk and have some understanding of speech and some response to it. As adults, they can get used to routines, but will need continuing direction and supervision in a protective environment.

Profound Retardation (approximate IQ less than 24): Profoundly retarded children may have other medical problems, such as cerebral palsy, and may need nursing care. They have delays in all areas of development. They show basic emotions and with training, may be able to use their legs, hands, and jaws. These children need close supervision. As adults they usually have simple speech and may walk. They usually benefit from regular physical activity. Because they are unable to take care of themselves, someone will need to give them complete support for daily living.

How is MR treated?

Tests such as newborn screening for phenylketonuria (PKU) and hypothyroidism can prevent some MR, but there is no cure for MR. Treatment focuses on educational, behavioral, and self-help skills. It is helpful when MR is diagnosed early in a child's life, so that therapy can begin as soon as possible. However, it is never too late to begin.

Many states offer Early Intervention Programs (EIP) for children aged 0 to 3 years with MR. Some states also offer special classes to children between the ages of 3 and 5 years who have special needs. By law, all states are required to provide special education classes for school-age children with MR until they are 21 years old. Every school board must tell parents their rights and follow the laws.

The school must develop an Individual Educational Plan (IEP) for each child requiring special education. This plan includes:

• educational objectives
• class placement
• a plan for checking progress
• any other special services, such as therapy or transportation.

The plan must be agreed upon by both the parent and the school.

Parents of children with MR often hear of new and different treatments through the media or friends. Your physician can help you decide if these treatments could help or harm your child.

Where can my family get help and support?

When parents hear for the first time that their child is mentally retarded, they can feel grief, anger, guilt, and many other difficult emotions. Many families find that professional counseling helps them to cope with the news. A child's disability affects the entire family, including brothers and sisters. Many times parents also need guidance on how to tell relatives their child has MR. Your physician and local organizations can direct you to therapists and parent support groups that can help you and your family deal with these important issues.

For More Information

National U.S. Organizations

Call or write to:

American Association on Mental Retardation
1719 Kalorama Rd., NW
Washington, DC 20009
800-424-3688

National Association for Retarded Citizens
500 E. Border Street, Suite 300
Arlington, TX 76010
817-261-6003

National Down Syndrome Congress
1800 Dempster Street
Park Ridge, IL 60068-1146
800-232-NDSC

National Fragile X Foundation of the USA
1441 York Street, Suite 215
Denver, CO 80206
800-688-8765

Suggested Reading

See:

Mental Retardation: Book List