What do retarded people act like

Down's syndrome ; poor prenatal care; infections during pregnancy; abnormal delivery; illness during infancy; toxic substances e.

Regardless of the cause, part of the definition of mental retardation is that it manifests itself during an individual's developmental period, usually deemed to be birth through age eighteen. Many psychiatrists argue that the age before which signs of retardation must become manifest should be raised from eighteen to twenty-two, to reflect the difficulties in obtaining accurate age records for many people with this disability and the differing rates at which people develop.

An ordinary adult cannot suddenly "become" mentally retarded. An adult may, for reasons related to accident or illness, suffer a catastrophic loss in intellectual functioning and adaptive skills, but this would not make him or her "mentally retarded," since by definition mental retardation starts during childhood.

One implication of this is that mental retardation is virtually impossible for an adult to fake: when evaluating whether an adult is mentally retarded, testers look not only at I. Early diagnosis can help the person with mental retardation obtain access to appropriate special education, training, clinical programs, and social services during important developmental years -- as well as through life.

With help from family, social workers, teachers, and friends, many mentally retarded people succeed in simple jobs, maintain their own households, marry, and give birth to children of normal intelligence. There is no "cure" for mental retardation. Characteristics and Significance of Mental Retardation. Although mental retardation of any degree has profound implications for a person's cognitive and social development, it is a condition which in many cases is not readily apparent. While some of the mentally retarded, such as those whose retardation is caused by Down's syndrome or fetal alcohol syndrome, have characteristically distinctive facial features, most cannot be identified by their physical appearance alone.

Unless their cognitive impairment is unusually severe e. Many capital offenders with mental retardation did not have their condition diagnosed until trial or during post-conviction proceedings. A person with mental retardation, according to one expert, "is always the least smart person in any group.

This leads to fear, dependence and an experience of terrible stigma and devaluation. They may wrap themselves in a "cloak of competence," hiding their disability even from those who want to help them, including their lawyers. At times, even competent lawyers who are anxious to help their clients may fail to identify their clients' retardation or may be unable to access funds for a psychological evaluation. Cruz nonetheless insisted to reporters that, although he was perhaps "slow in reading, slow in learning," he was not mentally retarded.

He had gone through much of his schooling allowing his younger sister to complete his homework for him. When he was given papers to read in connection to his case, he would carefully stare at them.

If he was asked a substantive question, he usually responded, "I don't recall. He lied about finishing high school.

He was actually in special education classes and did not finish the sixth grade. He was drafted into the army and discharged because of his mental retardation. He lied about his service record. He often made things up so that people would not suspect mental retardation. The fact that many people with mental retardation can and do live relatively "normal" lives with their families or in the community, coupled with the fact that most of them do not look different from people with average intellectual capabilities, can make it difficult for the public to appreciate the significance of their condition.

But, as the late U. A person with mental retardation will have limitations of a greater or lesser extent in every aspect of cognitive functioning. He or she will have limited abilities to learn including reading, writing, and arithmetic and to reason, plan, understand, judge, and discriminate. Mental retardation truncates the capacity to think about intended actions, to consider their possible consequences, and to exercise restraint.

One expert has summarized the attributes of mental retardation as follows:. Almost uniformly, individuals with mental retardation have grave difficulties in language and communication. They have problems with attention, memory, intellectual rigidity, and in moral development or moral understanding. They are susceptible to suggestion and readily acquiesce to other adults or authority figures People with mental retardation have limited knowledge because their impaired intelligence has prevented them from learning very much.

They also have grave problems in logic, foresight, planning, strategic thinking, and understanding consequences. Many of these limitations, of course, characterize children. But while children will outgrow these limitations as their brains develop and mature, people with mental retardation will not.

In limiting a person's cognitive development and ability to learn, mental retardation also limits the ability to understand abstract concepts, including moral concepts. While most defendants with mental retardation who have committed a crime know they have done something wrong, they often cannot explain why the act was wrong.

The inability to comprehend abstract concepts may include the inability to fully understand the meaning of "death" or "murder". Before his execution, Mason asked one of his legal advisors for advice on what to wear to his funeral. At his clemency hearing, the chair of the Louisiana pardons board asked Sawyer if he knew what murder was.

Sawyer responded, "That's when the breath leaves your body. Since they often face abuse, taunts, and rejection because of their low intelligence, people with mental retardation can be desperate for approval and friendship.

Eager to be accepted and eager to please, people with mental retardation are characteristically highly suggestible.

Washington was so suggestible and eager to please, according to a former employer, that "you could get [him] to confess that he walked on the moon. L ow intelligence and limited adaptive skills also mean that people with mental retardation often miss social "cues" that other adults understand.

Their inappropriate social responses can be misinterpreted by people who do not know they have mental retardation or who do not understand the nature of retardation. They may act in ways that seem suspicious, even when they have done nothing wrong.

When questioned by police or other authority figures, they often smile inappropriately, fail to remain still when ordered to do so, or act agitated and furtive when they should be calm and polite. Others may fall asleep at the wrong moment.

Welcome has mental retardation and, according to psychiatric testimony presented at his trial, has a mental age of eight. He smiled incessantly during his capital murder trial, an almost involuntary defense mechanism developed in response to a lifetime of taunts. As his defense attorney noted, "Many people with retardation smile a lot They are anxious for approval, and have learned that smiling is one way to get [it]. But they don't have the judgment to know when to smile.

He was sentenced to death and remains today on death row. Trial counsel were not aware that they had mental retardation. But their tendency to sleep peacefully during their trials helped alert post-conviction lawyers to their mental disability. In the case of White, who snored loudly during the penalty phase of his trial, the prosecutor argued that his conduct indicated his lack of remorse for his crime and his lack of respect for the criminal justice system. Both Fairchild and White were sentenced to death and executed.

Pediatr Rev ; This initial sharing of information with parents is an extremely important step and will probably set the stage for the future physician-family-patient relationship. Ample time should be scheduled to discuss the findings and to allow for questions, which will be numerous.

The family should be encouraged to write a list of questions for further communication with the physician. The Individuals with Disabilities Education Act 17 provides for developmental assessment of children older than three years in every school district. For children younger than three, similar infant-toddler assessment and early intervention resources are available, usually through local health departments, school districts or regional assessment centers.

The responsible agency varies in each state. Families will usually welcome such a referral and comprehensive evaluation, especially if the mental retardation is unexplained.

Evaluations by a nutritionist and a child psychiatrist may also be appropriate for some patients. The family physician should expect complete information on the findings from this type of team evaluation. The family should expect to be referred back to their local community for ongoing primary care and, in some instances, subspecialty care. Information about early intervention resources in the local community should be shared with the family, and appropriate support services should be identified.

If the child with mental retardation has a head circumference that falls below the 5th percentile microcephaly or above the 95th percentile macrocephaly , a magnetic resonance imaging scan of the brain should be considered. This is usually preferable to computed tomographic scanning because of the enhanced visualization of developmental abnormalities of the cerebral cortex, such as pachygyria, polymicrogyria and schizencephaly.

These disorders reflect an abnormality during the first 25 weeks of gestation in the early migration of the neurons into the normally six-layered cortex. This would include a review of a three-generation pedigree and records of pertinent relatives, evaluation for subtle dysmorphic features and assessment for a pattern to the patient's presenting characteristics. Most mentally retarded patients who visit a genetics office undergo chromosome analysis. While this testing could be done by the referring physician, there are different levels of test quality, and it is usually best performed by a good cytogenetics laboratory associated with a university hospital or children's hospital.

This allows for ease in interpretation of the results to the patient's family in the event an abnormality is found. DNA testing for fragile X syndrome should be done instead of cytogenetic testing, which can miss up to 7 percent of those who are affected. Diagnosis may require several periodic visits to a geneticist, because a phenotype may evolve slowly, and new syndromes are constantly being reported. The importance of making a diagnosis in a child with mental retardation cannot be overemphasized.

An accurate diagnosis allows for anticipatory guidance for the patient, recurrence risk information and genetic counseling for the parents, and opportunities for the family to become involved in specific support groups. An uncertain diagnosis should be conveyed as such; no diagnosis is preferable to an incorrect one. Within a given family, the risk of recurrence of mental retardation in future siblings or other relatives of the patient depends on the specific diagnosis.

The recurrence risk for mental retardation cannot be given to the family until a diagnosis has been made, although a general discussion with a geneticist may be of benefit. The family physician is a valuable resource in periodically reviewing the recurrence risk for the family. Practice guidelines for primary care of children with certain conditions Down syndrome, fragile X syndrome are also available, 19 — 21 as are special somatic growth charts for some syndromes. There are also guidelines for the management of adults with mental retardation who have been deinstitutionalized.

All physicians who care for children with mental retardation or developmental disabilities should remember that these patients quickly outgrow their childhoods.

As they become adolescents and young adults, most of them will need professional intervention to help them become their own advocates in the health care system.

Families should be supported as they encourage independent functioning on the part of their adolescent or young-adult son or daughter. Already a member or subscriber? Log in. Interested in AAFP membership?

Learn more. Address correspondence to Grace E. Holmes, M. Reprints are not available from the authors. Coplan J. Three pitfalls in the early diagnosis of mental retardation.

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Am J Med Genet. Evaluation of the child with idiopathic mental retardation. Pediatr Clin North Am. Outcome of extremely low birth weight infants to grams over a year period. Dimauro S, Moraes CT. Mitochondrial encephalomyopathies.

Arch Neurol. Smith's recognizable patterns of human malformation. Philadelphia: Saunders, Baraitser M, Winter RM. New York: Oxford University Press, The newly abbreviated and revised Denver developmental screening test. J Pediatr. The Denver developmental screening test. Denver developmental screening test II.

Denver: Denver Developmental Materials, The KIDS chart. A simple, reliable infant development screening tool. Am J Dis Child. Significance of minor abnormalities in children. Am Fam Physician. Congenital anomalies in the newborn infant, including minor variations. Pediatr Rev. The Individuals with Disabilities Education Act. A multicenter study on genotype-phenotype correlations in the fragile X syndrome, using direct diagnosis with probe StB Am J Hum Genet.

Health supervision for children with Down syndrome. American Academy of Pediatrics Committee on Genetics. Health supervision for children with fragile X syndrome. American Academy of Pediatrics Committeeon Genetics. Hayes A, Batshaw M. Down syndrome. Primary care of adults with mental retardation. J Fam Pract. Z Kinderchir. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.

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Next: Somatizing Patients: Part I. Practical Diagnosis. If care in an institution becomes necessary, it should be provided in surroundings and other circumstances as close as possible to those of normal life. The mentally retarded person has a right to a qualified guardian when this is required to protect his personal well-being and interests. The mentally retarded person has a right to protection from exploitation, abuse and degrading treatment. If prosecuted for any offence, he shall have a right to due process of law with full recognition being given to his degree of mental responsibility.

Whenever mentally retarded persons are unable, because of the severity of their handicap, to exercise all their rights in a meaningful way or it should become necessary to restrict or deny some or all of these rights, the procedure used for that restriction or denial of rights must contain proper legal safeguards against every form of abuse. This procedure must be based on an evaluation of the social capability of the mentally retarded person by qualified experts and must be subject to periodic review and to the right of appeal to higher authorities.

The core international human rights instruments. Universal human rights instruments.