Is Mental Retardation Still A Medical Term

The term "mental retardation" has a complex history within the field of medicine and special education. While it was once the standard terminology for describing individuals with significant cognitive impairments, it's now largely considered outdated and offensive. This article delves into the evolution of the term, its replacement with more appropriate language, the reasons behind the change, and the current medical and social understanding of intellectual disabilities.

Introduction: The Shift Away from "Mental Retardation"

For many years, "mental retardation" served as the official medical and psychological term to classify individuals with significant limitations in both intellectual functioning and adaptive behavior. However, over time, the term acquired negative connotations and was associated with stigma and discrimination. Recognizing the harm caused by this language, professionals and advocacy groups pushed for a change. The result was the adoption of "intellectual disability" as the preferred term, reflecting a more respectful and accurate understanding of the condition. This article will explore why this change occurred and what it means for individuals and families affected by intellectual disabilities.

The Historical Context of "Mental Retardation"

To understand why the term "mental retardation" is no longer considered acceptable, it's crucial to examine its historical usage and the evolution of societal attitudes toward individuals with intellectual disabilities.

Early Use in Medicine: The term emerged in the late 19th and early 20th centuries, initially intended as a neutral descriptor for individuals with cognitive impairments. It was used in medical and psychological literature to categorize different levels of intellectual disability.
Eugenics Movement: Unfortunately, the term became associated with the eugenics movement, which promoted discriminatory practices aimed at preventing individuals with disabilities from reproducing. This association contributed to the stigmatization of the term.
Social Stigma: Over time, "mental retardation" became a derogatory label used to insult and demean individuals with intellectual disabilities. This negative connotation made it increasingly difficult to use the term in a respectful and objective manner.
Advocacy for Change: As awareness of the harm caused by the term grew, advocacy groups and professionals began pushing for a change. They argued that the term was outdated, offensive, and inconsistent with the principles of inclusion and respect.

Why "Intellectual Disability" Replaced "Mental Retardation"

The movement to replace "mental retardation" with "intellectual disability" was driven by several key factors:

Reducing Stigma: The primary goal was to eliminate the negative connotations associated with "mental retardation." The term had become so stigmatized that it was difficult to use it without causing offense or perpetuating harmful stereotypes.
Promoting Respect: "Intellectual disability" was seen as a more respectful and person-centered term. It emphasizes the individual's intellectual abilities, rather than focusing on their limitations.
Aligning with International Standards: Many countries and international organizations had already adopted "intellectual disability" as the preferred term. This change helped to align the United States with global standards and promote consistency in terminology.
Reflecting a Broader Understanding: "Intellectual disability" reflects a more comprehensive understanding of the condition, recognizing that it encompasses a wide range of abilities and challenges. It also acknowledges the importance of adaptive behavior in assessing overall functioning.

The Official Shift in Terminology

The official shift from "mental retardation" to "intellectual disability" occurred through legislative and professional actions:

Rosa's Law (2010): In 2010, President Barack Obama signed Rosa's Law, which replaced "mental retardation" with "intellectual disability" in federal laws related to health, education, and labor. This law was named after Rosa Marcelli, a young girl with Down syndrome, whose family advocated for the change.
Diagnostic and Statistical Manual of Mental Disorders (DSM): The American Psychiatric Association updated the DSM to reflect the change in terminology. The DSM-5, published in 2013, uses "intellectual disability (intellectual developmental disorder)" as the diagnostic term.
American Association on Intellectual and Developmental Disabilities (AAIDD): The AAIDD, formerly known as the American Association on Mental Retardation, played a leading role in advocating for the change. The organization's name change reflected its commitment to using respectful and accurate language.

Understanding Intellectual Disability: Definition and Criteria

Intellectual disability is characterized by significant limitations in both intellectual functioning and adaptive behavior, which originate before the age of 18.

Intellectual Functioning: This refers to an individual's ability to reason, learn, solve problems, and understand abstract concepts. Intellectual functioning is typically assessed using standardized intelligence tests, such as the Wechsler Intelligence Scale for Children (WISC) or the Stanford-Binet Intelligence Scales. An IQ score of approximately 70 or below is generally considered indicative of intellectual disability.
Adaptive Behavior: This refers to an individual's ability to function independently in everyday life. Adaptive behavior includes skills such as communication, self-care, social skills, and practical skills. Adaptive behavior is typically assessed using standardized adaptive behavior scales, such as the Vineland Adaptive Behavior Scales.
Origin Before Age 18: The limitations in intellectual functioning and adaptive behavior must be present before the age of 18 for a diagnosis of intellectual disability to be made. This helps to distinguish intellectual disability from other conditions, such as dementia, which may develop later in life.

Levels of Intellectual Disability

Intellectual disability is classified into different levels of severity based on the individual's adaptive functioning and the level of support they require. These levels include:

Mild: Individuals with mild intellectual disability may have some difficulty learning academic skills, but they are generally able to live independently with minimal support. They may need assistance with complex tasks or decision-making.
Moderate: Individuals with moderate intellectual disability require more support than those with mild intellectual disability. They may have significant difficulties learning academic skills and may need assistance with daily living activities, such as dressing, bathing, and eating.
Severe: Individuals with severe intellectual disability require substantial support in all areas of life. They may have limited communication skills and may need assistance with basic self-care tasks.
Profound: Individuals with profound intellectual disability require constant support and supervision. They may have significant physical and sensory impairments, and they may need assistance with all aspects of daily living.

It's important to note that these levels are based on adaptive functioning, not just IQ scores. Adaptive functioning provides a more comprehensive picture of an individual's abilities and needs.

Causes and Risk Factors of Intellectual Disability

Intellectual disability can be caused by a variety of factors, including genetic conditions, prenatal factors, perinatal factors, and postnatal factors.

Genetic Conditions: Many genetic conditions are associated with intellectual disability, including Down syndrome, Fragile X syndrome, and Williams syndrome. These conditions are caused by abnormalities in an individual's genes or chromosomes.
Prenatal Factors: Prenatal factors that can increase the risk of intellectual disability include maternal infections (such as rubella or cytomegalovirus), exposure to toxins (such as alcohol or lead), and malnutrition.
Perinatal Factors: Perinatal factors that can increase the risk of intellectual disability include premature birth, low birth weight, and birth injuries.
Postnatal Factors: Postnatal factors that can increase the risk of intellectual disability include infections (such as meningitis or encephalitis), head injuries, and exposure to toxins.

In many cases, the cause of intellectual disability is unknown. It's important to remember that intellectual disability is not contagious and is not caused by poor parenting.

Diagnosis and Assessment of Intellectual Disability

The diagnosis of intellectual disability involves a comprehensive assessment of an individual's intellectual functioning and adaptive behavior. This assessment is typically conducted by a team of professionals, including psychologists, educators, and medical doctors.

Intellectual Functioning Assessment: Intellectual functioning is typically assessed using standardized intelligence tests, such as the Wechsler Intelligence Scale for Children (WISC) or the Stanford-Binet Intelligence Scales. These tests measure an individual's ability to reason, learn, solve problems, and understand abstract concepts.
Adaptive Behavior Assessment: Adaptive behavior is typically assessed using standardized adaptive behavior scales, such as the Vineland Adaptive Behavior Scales. These scales measure an individual's ability to function independently in everyday life, including skills such as communication, self-care, social skills, and practical skills.
Medical Evaluation: A medical evaluation is important to identify any underlying medical conditions that may be contributing to the individual's intellectual disability. This evaluation may include a physical examination, laboratory tests, and imaging studies.
Educational Assessment: An educational assessment is important to determine the individual's academic strengths and weaknesses, as well as their learning style and educational needs.

The results of these assessments are used to determine whether an individual meets the criteria for intellectual disability and to develop an individualized education program (IEP) or other support plan.

Support and Treatment for Individuals with Intellectual Disability

Individuals with intellectual disability benefit from a variety of support and treatment options, including:

Early Intervention Services: Early intervention services are designed to support young children with intellectual disability and their families. These services may include speech therapy, occupational therapy, physical therapy, and developmental therapy.
Special Education Services: Special education services are designed to meet the unique educational needs of students with intellectual disability. These services may include individualized instruction, assistive technology, and vocational training.
Therapy: Therapy can help individuals with intellectual disability to develop communication skills, social skills, and coping skills. Therapy may include speech therapy, occupational therapy, physical therapy, and behavioral therapy.
Vocational Training: Vocational training can help individuals with intellectual disability to develop job skills and find employment. Vocational training programs may include job coaching, on-the-job training, and supported employment.
Residential Services: Residential services provide housing and support for individuals with intellectual disability who are unable to live independently. Residential services may include group homes, supported living arrangements, and residential care facilities.
Family Support Services: Family support services provide support and resources for families who have a child with intellectual disability. These services may include respite care, counseling, and support groups.

The goal of support and treatment is to help individuals with intellectual disability to reach their full potential and live as independently as possible.

The Importance of Inclusion and Advocacy

Inclusion and advocacy are essential for promoting the rights and well-being of individuals with intellectual disability.

Inclusion: Inclusion means ensuring that individuals with intellectual disability have the opportunity to participate in all aspects of community life, including education, employment, recreation, and social activities.
Advocacy: Advocacy means speaking up for the rights and needs of individuals with intellectual disability. This may involve working to change laws and policies, raising awareness about intellectual disability, and challenging discrimination.

By promoting inclusion and advocacy, we can create a more just and equitable society for individuals with intellectual disability.

Current Perspectives on Intellectual Disability

Today, intellectual disability is viewed through a more nuanced and person-centered lens. This includes:

Focus on Strengths: Rather than solely focusing on limitations, there's an increasing emphasis on identifying and building upon the strengths and abilities of individuals with intellectual disabilities.
Self-Determination: Promoting self-determination is key, encouraging individuals to make their own choices and have control over their lives to the greatest extent possible.
Person-Centered Planning: Support plans are now often developed using a person-centered approach, which takes into account the individual's unique goals, preferences, and needs.
Community Integration: The goal is to support individuals in living, working, and participating in their communities, rather than segregating them in institutional settings.

Conclusion: Embracing Respectful Language and Inclusive Practices

While "mental retardation" was once a common term, its negative connotations and stigmatizing effects led to its replacement with "intellectual disability." This change reflects a broader shift towards more respectful and person-centered language in the field of disability. By understanding the history of the term, the reasons for the change, and the current understanding of intellectual disability, we can work together to create a more inclusive and supportive society for individuals with intellectual disabilities and their families. The journey towards respectful language and inclusive practices is ongoing, requiring continued education, advocacy, and a commitment to treating all individuals with dignity and respect.