Intellectual disability

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https://en.wikipedia.org/wiki/Intellectual_disability 

 

Intellectual disability
Other names	Intellectual developmental disability (IDD), general learning disability
Children with intellectual disabilities and other developmental conditions competing in the Special Olympics.
Specialty	Psychiatry, pediatrics
Frequency	153 million (2015)

Intellectual disability (ID), also known as general learning disability and mental retardation (MR), is a generalized neurodevelopmental disorder characterized by significantly impaired intellectual and adaptive functioning. It is defined by an IQ under 70, in addition to deficits in two or more adaptive behaviors that affect everyday, general living.

Once focused almost entirely on cognition, the definition now includes both a component relating to mental functioning and one relating to an individual's functional skills in their daily environment. As a result of this focus on the person's abilities in practice, a person with an unusually low IQ may still not be considered to have intellectual disability.

Intellectual disability is subdivided into syndromic intellectual disability, in which intellectual deficits associated with other medical and behavioral signs and symptoms are present, and non-syndromic intellectual disability, in which intellectual deficits appear without other abnormalities. Down syndrome and fragile X syndrome are examples of syndromic intellectual disabilities.

Intellectual disability affects about 2–3% of the general population. Seventy-five to ninety percent of the affected people have mild intellectual disability. Non-syndromic, or idiopathic cases account for 30–50% of these cases. About a quarter of cases are caused by a genetic disorder, and about 5% of cases are inherited from a person's parents. Cases of unknown cause affect about 95 million people as of 2013.

Signs and symptoms

Intellectual disability (ID) becomes apparent during childhood and involves deficits in mental abilities, social skills, and core activities of daily living (ADLs) when compared to same-aged peers. There often are no physical signs of mild forms of ID, although there may be characteristic physical traits when it is associated with a genetic disorder (e.g., Down syndrome).

The level of impairment ranges in severity for each person. Some of the early signs can include:

• Delays in reaching, or failure to achieve milestones in motor skills development (sitting, crawling, walking)
• Slowness learning to talk, or continued difficulties with speech and language skills after starting to talk
• Difficulty with self-help and self-care skills (e.g., getting dressed, washing, and feeding themselves)
• Poor planning or problem-solving abilities
• Behavioral and social problems
• Failure to grow intellectually, or continued infant childlike behavior
• Problems keeping up in school
• Failure to adapt or adjust to new situations
• Difficulty understanding and following social rules

In early childhood, mild ID (IQ 50–69) may not be obvious or identified until children begin school. Even when poor academic performance is recognized, it may take expert assessment to distinguish mild intellectual disability from specific learning disability or emotional/behavioral disorders. People with mild ID are capable of learning reading and mathematics skills to approximately the level of a typical child aged nine to twelve. They can learn self-care and practical skills, such as cooking or using the local mass transit system. As individuals with intellectual disability reach adulthood, many learn to live independently and maintain gainful employment.

Moderate ID (IQ 35–49) is nearly always apparent within the first years of life. Speech delays are particularly common signs of moderate ID. People with moderate intellectual disability need considerable supports in school, at home, and in the community in order to fully participate. While their academic potential is limited, they can learn simple health and safety skills and to participate in simple activities. 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.

People with Severe (IQ 20–34) or Profound ID (IQ 19 or below) need more intensive support and supervision for their entire lives. They may learn some ADLs, but an intellectual disability is considered severe or profound when individuals are unable to independently care for themselves without ongoing significant assistance from a caregiver throughout adulthood. Individuals with profound ID are completely dependent on others for all ADLs and to maintain their physical health and safety. They may be able to learn to participate in some of these activities to limited degree.

Co-morbidity

Autism and intellectual disability

Intellectual disability and autism spectrum disorder (ASD) share clinical characteristics which can result in confusion while diagnosing. Overlapping these two disorders, while common, can be detrimental to a person's well being. Those with ASD that hold symptoms of ID may be grouped into a co-diagnosis in which they are receiving treatment for a disorder they do not have. Likewise, those with ID that are mistaken to have ASD may be treated for symptoms of a disorder they do not have. Differentiating between these two disorders will allow clinicians to deliver or prescribe the appropriate treatments. Comorbidity between ID and ASD is very common; roughly 40% of those with ID also have ASD and roughly 70% of those with ASD also have ID. Both ASD and ID require shortfalls in communication and social awareness as defining criteria. Both ASD and ID are classified by severity; mild, moderate, severe. In addition to those three levels, ID has a fourth classification known as profound.

Defining differences

In a study conducted in 2016 surveying 2816 cases, it was found that the top subsets that help differentiate between those with ID and ASD are, "...impaired non-verbal social behavior and lack of social reciprocity, [...] restricted interests, strict adherence to routines, stereotyped and repetitive motor mannerisms, and preoccupation with parts of objects". Those with ASD tend to show more deficits in non-verbal social behavior such as body language and understanding social cues. In a study done in 2008 of 336 individuals with varying levels of ID, it was found that those with ID display fewer instances of repetitive or ritualistic behaviors. It also recognized that those with ASD, when compared to those with ID, were more likely to isolate themselves and make less eye contact. When it comes to classification ID and ASD have very different guidelines. ID has a standardized assessment called the Supports Intensity Scale (SIS), this measures severity on a system built around how much support an individual will need. While ASD also classifies severity by support needed there is no standard assessment, clinicians are free to diagnose severity at their own judgment.

Causes

Down syndrome is the most common genetic cause of intellectual disability.

Among children, the cause of intellectual disability is unknown for one-third to one-half of cases. About 5% of cases are inherited from a person's parents. Genetic defects that cause intellectual disability, but are not inherited, can be caused by accidents or mutations in genetic development. Examples of such accidents are development of an extra chromosome 18 (trisomy 18) and Down syndrome, which is the most common genetic cause. Velocardiofacial syndrome and fetal alcohol spectrum disorders are the two next most common causes. However, there are many other causes. The most common are:

• Genetic conditions. Sometimes disability is caused by abnormal genes inherited from parents, errors when genes combine, or other reasons. The most prevalent genetic conditions include Down syndrome, Klinefelter syndrome, Fragile X syndrome (common among boys), neurofibromatosis, congenital hypothyroidism, Williams syndrome, phenylketonuria (PKU), and Prader–Willi syndrome. Other genetic conditions include Phelan-McDermid syndrome (22q13del), Mowat–Wilson syndrome, genetic ciliopathy, and Siderius type X-linked intellectual disability (OMIM 300263) as caused by mutations in the PHF8 gene (OMIM 300560).^[17][18] In the rarest of cases, abnormalities with the X or Y chromosome may also cause disability. 48, XXXX and 49, XXXXX syndrome affect a small number of girls worldwide, while boys may be affected by 49, XXXXY, or 49, XYYYY. 47, XYY is not associated with significantly lowered IQ though affected individuals may have slightly lower IQs than non-affected siblings on average.
• Problems during pregnancy. Intellectual disability can result when the fetus does not develop properly. For example, there may be a problem with the way the fetus's cells divide as it grows. A pregnant woman who drinks alcohol (see fetal alcohol spectrum disorder) or gets an infection like rubella during pregnancy may also have a baby with intellectual disability.
• Problems at birth. If a baby has problems during labor and birth, such as not getting enough oxygen, he or she may have developmental disability due to brain damage.
• Exposure to certain types of disease or toxins. Diseases like whooping cough, measles, or meningitis can cause intellectual disability if medical care is delayed or inadequate. Exposure to poisons like lead or mercury may also affect mental ability.
• Iodine deficiency, affecting approximately 2 billion people worldwide, is the leading preventable cause of intellectual disability in areas of the developing world where iodine deficiency is endemic. Iodine deficiency also causes goiter, an enlargement of the thyroid gland. More common than full-fledged cretinism, as intellectual disability caused by severe iodine deficiency is called, is mild impairment of intelligence. Residents of certain areas of the world, due to natural deficiency and governmental inaction, are severely affected by iodine deficiency. India has 500 million suffering from deficiency, 54 million from goiter, and 2 million from cretinism. Among other nations affected by iodine deficiency, China and Kazakhstan have instituted widespread salt iodization programs. But, as of 2006, Russia had not.
• Malnutrition is a common cause of reduced intelligence in parts of the world affected by famine, such as Ethiopia and nations struggling with extended periods of warfare that disrupt agriculture production and distribution.
• Absence of the arcuate fasciculus.

Diagnosis

According to both the American Association on Intellectual and Developmental Disabilities(Intellectual Disability: Definition, Classification, and Systems of Supports (11th Edition) and the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), three criteria must be met for a diagnosis of intellectual disability: significant limitation in general mental abilities (intellectual functioning), significant limitations in one or more areas of adaptive behavior across multiple environments (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 in childhood or adolescence. In general, people with intellectual disability have an IQ below 70, but clinical discretion may be necessary for individuals who have a somewhat higher IQ but severe impairment in adaptive functioning.

It is formally diagnosed by an assessment of IQ and adaptive behavior. A third condition requiring onset during the developmental period is used to distinguish intellectual disability from other conditions, such as traumatic brain injuries and dementias (including Alzheimer's disease).

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 in specific learning disability), or acquired later in life through acquired brain injuries or neurodegenerative diseases like dementia. Cognitive deficits may appear at any age. Developmental disability is any disability that is due to problems with growth 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.

Limitations in more than one area

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:

• Daily living skills, such as getting dressed, using the bathroom, and feeding oneself
• Communication skills, such as understanding what is said and being able to answer
• Social skills with peers, family members, spouses, adults, and others

Other specific skills can be critical to an individual's inclusion in the community and to developing appropriate social behaviours, as for example being aware of the different social expectations linked to the principal lifespan stages (i.e., childhood, adulthood, old age). The results of a Swiss study suggest that the performance of adults with ID in recognizing different lifespan stages is related to specific cognitive abilities and to the type of material used to test this performance.

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. Causes, such as congenital hypothyroidism, if detected early may be treated to prevent development of an intellectual disability.

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. Psychosocial treatments are intended primarily for children before and during the preschool years as this is the optimum time for intervention. 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. 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.

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. 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. 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. Cognitive-behavioral treatments, a combination of the previous two treatment types, involves a strategical-metastrategical learning technique 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. 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. 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 as benzodiazepines in people with intellectual disability requires monitoring and vigilance as side effects occur commonly and are often misdiagnosed as behavioral and psychiatric problems.

Epidemiology

Intellectual disability affects about 2–3% of the general population. 75–90% of the affected people have mild intellectual disability. Non-syndromic or idiopathic ID accounts for 30–50% of cases. About a quarter of cases are caused by a genetic disorder. Cases of unknown cause affect about 95 million people as of 2013. It is more common in males and in low to middle income countries.

History

Intellectual disability has 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 disability were commonly viewed as burdens on their families.

Greek and Roman philosophers, who valued reasoning abilities, disparaged people with intellectual disability as barely human. 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.

Caliph Al-Walid (r. 705–715) built one of the first care homes for intellectually disabled individuals and built the first hospital which accommodated intellectually disabled individuals as part of its services. In addition, Al-Walid assigned each intellectually disabled individual a caregiver.

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 disability to be incapable of making decisions or managing their affairs. Guardianships were created to take over their financial affairs.

In the 17th century, Thomas Willis provided the first description of intellectual disability as a disease. 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. 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 surveyed, 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).

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 disability. 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 Adolf Hitler as a rationale for the mass murder of people with intellectual disability 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.

Although ancient Roman law had declared people with intellectual disability to be incapable of the deliberate intent to harm that was necessary for a person to commit a crime, during the 1920s, Western society believed they were morally degenerate.

Ignoring the prevailing attitude, Civitans adopted service to people with developmental disabilities as a major organizational emphasis in 1952. Their earliest efforts included workshops for special education teachers and daycamps for children with disabilities, all at a time when such training and programs were almost nonexistent. The segregation of people with developmental disabilities was not 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", 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. Normalization and deinstitutionalization are dominant. Along with the work of Wolfensberger and others including Gunnar and Rosemary Dybwad, 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.

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.

In the past, lead poisoning and infectious diseases were significant causes of intellectual disability. 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.

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.

Terminology

The terms used for this condition are subject to a process called the euphemism 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 included "imbecile" and "moron" and are now considered 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. The term intellectual disability is now preferred by most advocates and researchers in most English-speaking countries.

The term "mental retardation" was used in the American Psychiatric Association's DSM-IV (1994) and in the World Health Organization's ICD-10 (codes F70–F79). In the next revision, the ICD-11, this term has been replaced by the term "disorders of intellectual development" (codes 6A00–6A04; 6A00.Z for the "unspecified" diagnosis code). The term "intellectual disability (intellectual developmental disorder)" is used in DSM-5 (2013). As of 2013, "intellectual disability (intellectual developmental disorder)" is the term that has come into common use by among educational, psychiatric, and other professionals over the past two decades. 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.

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.

Vaguer expressions like developmentally disabled, special, or challenged have been used instead of the term mentally retarded. The term developmental delay was 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 having a lifelong condition.

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.

• Cretin is the oldest and comes from a dialectal French word for Christian. 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 has not been 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. Theodor Meynert in the 1890s lectures described amentia as a form of sudden-onset confusion (German: Verwirrtheit), often with hallucinations. This term was long in use in psychiatry in this sense. Emil Kraepelin in the 1910s wrote that “acute confusion (amentia)” is a form of febrile delirium. By 1912, amentia was a classification lumping "idiots, imbeciles, and feeble minded" individuals in a category separate from a dementia classification, in which the onset is later in life. In Russian psychiatry the term “amentia” defines a form of clouding of consciousness, which is dominated by confusion, true hallucinations, incoherence of thinking and speech and chaotic movements. In Russia “amentia” (Russian: аменция) is not associated with intellectual disability and mean only clouding of consciousness.
• 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 term profound 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 and Mongoloid idiot were medical terms used to identify someone with Down syndrome, as the doctor who first described the syndrome, John Langdon Down, believed that children with Down syndrome shared facial similarities with Blumenbach's "Mongolian race". The Mongolian People's Republic requested 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 mentally 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; a BBC survey in 2003 ranked it as the most offensive disability-related word, ahead of terms such as spastic (or its abbreviation spaz) and mong. The terms mentally retarded and mental retardation are still fairly common, but currently the Special Olympics, Best Buddies, and over 100 other organizations are striving to eliminate their use by referring to the word retard and its variants as the "r-word", in an effort to equate it to the word nigger and the associated euphemism "n-word", in everyday conversation. These efforts have resulted in federal legislation, sometimes known as "Rosa's Law", to replace the term mentally retarded with the term intellectual disability in some federal statutes.
  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. It 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, developmental disability and developmental delay (for people under the age of 18) are generally considered more polite terms than mental retardation.

United States

Special Olympics USA team in July 2019

• In North America, intellectual disability is subsumed into the broader term developmental disability, which also includes epilepsy, 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. It is not specific to congenital disorders such as Down syndrome.

The American Association on Mental Retardation changed its name to the American Association on Intellectual and Developmental Disabilities (AAIDD) in 2007, and soon thereafter changed the names of its scholarly journals to reflect the term "intellectual disability". In 2010, the AAIDD released its 11th edition of its terminology and classification manual, which also used the term intellectual disability.

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. 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". British social workers may use "learning difficulty" to refer to both people with intellectual disability and those with conditions such as dyslexia. 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.

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." 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. 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.

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.

Society and culture

Severely disabled girl in Bhutan

People with intellectual 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 intellectually disabilities, which means allowing them 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 peers who were segregated in special schools, students who are mainstreamed or included in regular classrooms report similar levels of stigma and social self-conception, but more ambitious plans for employment. As adults, they may live independently, with family members, or in different types of institutions organized to support people with disabilities. About 8% currently live in an institution or a group home.

In the United States, the average lifetime cost of a person with an intellectual disability amounts to $223,000 per person, in 2003 US dollars, for direct costs such as medical and educational expenses. The indirect costs were estimated at $771,000, due to shorter lifespans and lower than average economic productivity. The total direct and indirect costs, which amount to a little more than a million dollars, are slightly more than the economic costs associated with cerebral palsy, and double that associated with serious vision or hearing impairments. Of the costs, about 14% is due to increased medical expenses (not including what is normally incurred by the typical person), and 10% is due to direct non-medical expenses, such as the excess cost of special education compared to standard schooling. The largest amount, 76%, is indirect costs accounting for reduced productivity and shortened lifespans. Some expenses, such as ongoing costs to family caregivers or the extra costs associated with living in a group home, were excluded from this calculation.

Health disparities

People with intellectual disability are usually at a higher risk of living with complex health conditions such as epilepsy and neurological disorders, gastrointestinal disorders, and behavioral and psychiatric problems compared to people without disabilities. Adults also have a higher prevalence of poor social determinants of health, behavioral risk factors, depression, diabetes, and poor or fair health status than adults without intellectual disability.

In the United Kingdom people with intellectual disability live on average 16 years less than the general population. Some of the barriers that exist for people with ID accessing quality healthcare include: communication challenges, service eligibility, lack of training for healthcare providers, diagnostic overshadowing, and absence of targeted health promotion services. Key recommendations from the CDC for improving the health status for people with intellectual disabilities include: improve access to health care, improve data collection, strengthen the workforce, include people with ID in public health programs, and prepare for emergencies with people with disabilities in mind.

Alcoholism in family systems

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Alcoholism_in_family_systems 

Alcoholism in family systems refers to the conditions in families that enable alcoholism, and the effects of alcoholic behavior by one or more family members on the rest of the family. Mental health professionals are increasingly considering alcoholism and addiction as diseases that flourish in and are enabled by family systems.

Family members react to the alcoholic with particular behavioral patterns. They may enable the addiction to continue by shielding the addict from the negative consequences of their actions. Such behaviors are referred to as codependence. In this way, the alcoholic is said to suffer from the disease of addiction, whereas the family members suffer from the disease of codependence. While it is recognized that addiction is a family disease, affecting the entire family system, "the family is often ignored and neglected in the treatment of addictive disease."  Each individual member is affected and should receive treatment for their own benefit and healing, but in addition to benefitting the individuals themselves, this also helps to better support the addict/alcoholic in his/her recovery process. "The chances of recovery are greatly reduced unless the co-dependents are willing to accept their role in the addictive process and submit to treatment themselves."  "Co-dependents are mutually dependent on the addict to fulfill some need of their own." 

For example, the "Chief Enabler" (the main enabler in the family) will often turn a blind eye to the addict's drug/alcohol use as this allows for the enabler to continue to play the victim and/or martyr role, while allowing the addict to continue his/her own destructive behavior. Therefore, "the behavior of each reinforces and maintains the other, while also raising the costs and emotional consequences for both." 

Alcoholism is one of the leading causes of a dysfunctional family. "About one-fourth of the U.S. population is a member of family that is affected by an addictive disorder in a first-degree relative."  As of 2001, there were an estimated 26.8 million children of alcoholics (COAs) in the United States, with as many as 11 million of them under the age of 18. Children of addicts have an increased suicide rate and on average have total health care costs 32 percent greater than children of nonalcoholic families.

According to the American Psychiatric Association, physicians stated three criteria to diagnose this disease: (1) physiological problems, such as hand tremors and blackouts, (2) psychological problems, such as excessive desire to drink, and (3) behavioral problems that disrupt social interaction or work performance.

Adults from alcoholic families experience higher levels of state and trait anxiety and lower levels of differentiation of self than adults raised in non-alcoholic families. Additionally, adult children of alcoholics have lower self-esteem, excessive feelings of responsibility, difficulties reaching out, higher incidence of depression, and increased likelihood of becoming alcoholics.

Parental alcoholism may affect the fetus even before a child is born. In pregnant women, alcohol is carried to all of the mother's organs and tissues, including the placenta, where it easily crosses through the membrane separating the maternal and fetal blood systems. When a pregnant woman drinks an alcoholic beverage, the concentration of alcohol in her unborn baby's bloodstream is the same level as her own. A pregnant woman who consumes alcohol during her pregnancy may give birth to a baby with fetal alcohol syndrome (FAS). FAS is known to produce children with damage to the central nervous system, general growth and facial features. The prevalence of this class of disorder is thought to be between 2–5 per 1000.

Alcoholism does not have uniform effects on all families. The levels of dysfunction and resiliency of the non-alcoholic adults are important factors in effects on children in the family. Children of untreated alcoholics score lower on measures of family cohesion, intellectual-cultural orientation, active-recreational orientation, and independence. They have higher levels of conflict within the family, and many experience other family members as distant and non-communicative. In families with untreated alcoholics, the cumulative effect of the family dysfunction may affect the children's ability to grow in developmentally healthy ways.

Family roles

The role of the "Chief Enabler" is typically the spouse, significant other, parent, or eldest child of the alcoholic/addict. This person demonstrates "a strong tendency to avoid any confrontation of the addictive behavior and a subconscious effort to actively perpetuate the addiction." The "Chief Enabler" also often doubles as the "Responsible One," or "Family Hero" another role assumed by family members of the alcoholic/addict. Both the "Chief Enabler" and "Responsible One" (aka "Model Child"^[4]) will take "over [the alcoholic/addict's] roles and responsibilities." For example, a parent might pay for expenses and take over responsibilities (i.e. car payments, the raising of a grandchild, provide room and board, etc.), while a child may provide care for their siblings, become the "peace keeper" in the home, take on all the chores and cooking, etc. A spouse or significant other may overcompensate by providing all the care to the children, being the sole financial contributor to the household, covering up or hiding the addiction from others, etc. This role often receives the most praise from non-family members, causing the individual to struggle to see that it is an unhealthy role which contributes to the addict/alcoholic's disease as well as the family's dysfunction. 

Another role is that of the "Problem Child" or "Scapegoat." This person "may be the only [one] clearly seen as having a problem" outside of the actual addict/alcoholic. This child (or adult child of the alcoholic(s)) "gets blamed for everything; they have problems at school, exhibit negative behavior, and often develop drug or alcohol problems as a way to act out. Their behavior demands whatever attention is available from parents and siblings." This often "takes the focus off the parental alcohol problem," and the child can be the "scapegoat" under the myth that his/her behavior fuels the parent's drinking/using. However, this child draws attention from outsiders, which may contribute to the recognition of the family alcohol problem by outsiders.

The "Lost Child" role is identified in this system through children that are "withdrawn, 'spaced-out,' and disconnected from the life and emotions around them." They often avoid "any emotionally confronting issues, [and so are] unable to form close friendships or intimate bonds with others." 

Other children "trivialize things by minimizing all serious issues as an avoidance strategy [and] are well liked and easy to befriend but are usually superficial in all relationships, including those with their own family members."  These children are known as the "Mascot" or "Family Clown." 

However, alcoholic family roles have not withstood the standards that psychological theories of personality are typically subjected to. The evidence for alcoholic family roles theory provides limited or no construct validity or clinical utility.

Prevalence

Based on the number of children with parents meeting the DSM-V criteria for alcohol abuse or alcohol dependence, in 1996 there were an estimated 26.8 million children of alcoholics (COAs) in the United States of which 11 million were under the age of 18. As of 1988, it was estimated that 76 million Americans, about 43% of the U.S. adult population, have been exposed to alcoholism or problem drinking in the family, either having grown up with an alcoholic, having an alcoholic blood relative, or marrying an alcoholic. While growing up, nearly one in five adult Americans (18%) lived with an alcoholic. In 1992, it was estimated that one in eight adult American drinkers were alcoholics or experienced problems as consequences of their alcohol use.

Familiality

Children of alcoholics (COAs) are more susceptible to alcoholism and other drug abuse than children of non-alcoholics. Children of alcoholics are four times more likely than non-COAs to develop alcoholism. Both genetic and environmental factors influence the development of alcoholism in COAs.

COAs perceptions of their parents drinking habits influence their own future drinking patterns and are developed at an early age. Alcohol related expectancies are correlated with parental alcoholism and alcohol abuse among their offspring. Problem solving discussions in families with an alcoholic parent contained more negative family interactions than in families with non-alcoholics parents. Several factors related to parental alcoholism influence COA substance abuse including stress, negative affect and decreased parental monitoring. Impaired parental monitoring and negative affect correlate with COAs associating with peers that support drug use.

After drinking alcohol, sons of alcoholics experience more of the physiological changes associated with pleasurable effects compared with sons of non-alcoholics, although only immediately after drinking.

Compared with non-alcoholic families, alcoholic families demonstrate poorer problem-solving abilities, both among the parents and within the family as a whole. These communication problems many contribute to the escalation of conflicts in alcoholic families. COAs are more likely than non-COAs to be aggressive, impulsive, and engage in disruptive and sensation seeking behaviors. Alcohol addiction is a complex disease that results from a variety of genetic, social, and environmental influences. Alcoholism affected approximately 4.65 percent of the U.S. population in 2001–2002, producing severe economic, social, and medical ramifications (Grant 2004). Researchers estimate that between 50 and 60 percent of alcoholism risk is determined by genetics (Goldman and Bergen 1998; McGue 1999).This strong genetic component has sparked numerous linkage and association studies investigating the roles of chromosomal regions and genetic variants in determining alcoholism susceptibility.

Marital relationships

Alcoholism usually has strong negative effects on marital relationships. Separated and divorced men and women were three times as likely as married men and women to say they had been married to an alcoholic or problem drinker. Almost two-thirds of separated and divorced women, and almost half of separated or divorced men under age 46 have been exposed to alcoholism in the family at some time.

Exposure was higher among women (46.2 percent) than among men (38.9 percent) and declined with age. Exposure to alcoholism in the family was strongly related to marital status, independent of age: 55.5 percent of separated or divorced adults had been exposed to alcoholism in some family member, compared with 43.5 percent of married, 38.5 percent of never married, and 35.5 percent of widowed persons. Nearly 38 percent of separated or divorced women had been married to an alcoholic, but only about 12 percent of currently married women were married to an alcoholic.

Children

Prevalence of abuse

Over one million children yearly are confirmed as victims of child abuse and neglect by state child protective service agencies. Substance abuse is one of the two largest problems affecting families in the United States, being a factor in nearly four-fifths of reported cases. Alcoholism is more prevalent among child abusing parents. Alcoholism is more strongly correlated to child abuse than depression and other disorders.

Adoption plays only a slight role in alcoholism in the family. Studies were done comparing children who were born into a family with an alcoholic parent and raised by adoptive (non-alcoholic) parents as compared to children born to non-alcoholic parents and raised by adopted alcoholic parents. The results (in US and Scandinavian studies) were that those adopted children born of an alcoholic parent (and adopted by non-alcoholic parents ) developed alcoholism at higher rates as adults.

Correlates

Children of alcoholics exhibit symptoms of depression and anxiety more than children of non-alcoholics. COAs have lower self-esteem than non-COAs from childhood through young adulthood. Children of alcoholics show more symptoms of anxiety, depression, and externalizing behavior disorders than non-COAs. Some of these symptoms include crying, lack of friends, fear of going to school, nightmares, perfectionism, hoarding, and excessive self-consciousness.

Many children of alcoholics score lower on tests measuring cognitive and verbal skills than non-COAs. Lacking requisite skills to express themselves can impact academic performance, relationships, and job interviews. The lack of these skills do not, however, imply that COAs are intellectually impaired. COAs are also shown to have difficulty with abstraction and conceptual reasoning, both of which play an important role in problem-solving academically and otherwise.

In her book Adult Children of Alcoholics, Janet G. Woititz describes numerous traits common among adults who had an alcoholic parent. Although not necessarily universal or comprehensive, these traits constitute an adult children of alcoholics syndrome (cf. the work of Wayne Kritsberg).

Coping Mechanism

Suggested practices to mitigate the impact of parental alcoholism on the development of their children include:

• Maintaining healthy family traditions and practices, such as vacations, mealtimes, and holidays
• Encouraging COAs to develop consistent, stable, relationships with significant others outside of the family.
• Planning non-drinking activities to compete with alcoholic behaviour and tendencies.

Resilience

Professor and psychiatric Dieter J. Meyerhoff state that the negative effects of alcohol on the body and on health are undeniable, but we should not forget the most important unit in our society that this is affects the family and the children. The family is the main institution in which the child should feel safe and have moral values. If a good starting point is given, it is less likely that when a child becomes an adult, has a mental disorder or is addicted to drugs or alcohol. According to the American Academy of Child and Adolescent Psychiatry (AACAP) children are in a unique position when their parents abuse alcohol. The behavior of a parent is the essence of the problem, because such children do not have and do not receive support from their own family. Seeing changes from happy to angry parents, the children begin to think that they are the reason for these changes. Self-accusation, guilt, frustration, anger arises because the child is trying to understand why this behavior is occurs. Dependence on alcohol has a huge harm in childhood and adolescent psychology in a family environment. Psychologists Michelle L. Kelley and Keith Klostermann describe the effects of parental alcoholism on children, and describe the development and behavior of these children. Alcoholic children often face problems such as behavioral disorders, oppression, crime and attention deficit disorder, and there is a higher risk of internal behavior, such as depression and anxiety. Therefore, they are drinking earlier, drinking alcohol more often and are more likely to grow from moderate to severe alcohol consumption. Young people with parental abuse and parental violence are likely to live in large crime areas, which may have a negative impact on the quality of schools and increase the impact of violence in the area. Paternity alcoholism and the general parental verbal and physical spirit of violence witnessed the fears of children and the internalization of symptoms, greater likelihood of child aggression and emotional misconduct. Research on alcoholism within families has leaned towards exploring issues that are wrong in the community rather than potential strengths or positives. When researchers conduct research that helps communities, it can be easier for community members to identify with the positives and work towards a path of resilience. Flawed research design in adult children of alcoholics (ACOA) research showed ACOAs were psychologically damaged. Some flawed research designs include using ACOAs as part of the control group and comparing them to other ACOAs within the same study. This may have caused some limitations in the study that were not listed. When comparing ACOAs to other ACOAs, it is difficult to interpret accurate results that show certain behaviors in the group studied. Research that has been conducted more recently has used control groups with non-ACOAs to see whether the behaviors align with prior research. This research has shown that behaviors were similar between non-ACOAs and ACOAs. An 18-year-long study compared children of alcoholics (COA) to other COAs. In failing to use non-COAs as controls, we miss an opportunity to see if the negative aspects of a person are related to having an alcoholic parent, or are they just simply a fact of life. For example, in Werner's study, he found that 30% of COAs were committing serious delinquencies. This data would have been more usable if they had viewed the percentage of those committing crimes when compared to non-ACOAs. In a study conducted in a midwestern university, researchers found that there was no significant difference between ACOA and non-ACOA students. One of the main differences was the student's views on how they connect their past experiences with their current social-emotional functioning. Students who were ACOAs did not demonstrate issues with their perspective on their interpersonal issues any more than the non-ACA students. However, this study did show that there were other underlying problems in the family structure that may attribute to the perception of not being well adjusted in life.

Due to the flawed research that has been conducted in the past, many stereotypes have followed ACOAs. ACOAs have been identified as having a variety of emotional and behavioral problems, such as sleep problems, aggression and lowered self-esteem. When it comes to being a COA or ACOA, there is still hope. Results showed that a supportive and loving relationship with one of the parents can counterbalance the possible negative effects of the relationship with the alcoholic parent. When there is one alcoholic parent in the household, it helps if the child relies on other family members for support. It may be the second parent, siblings or members of the extended family. Having other supportive family members can help the child feel like s/he is not alone. Younger generations of ACOAs scored more positively, in terms of coping mechanisms. This may be due to fact that alcoholism is seen more as an illness nowadays, rather than a moral defect. There has been less victim blaming of alcoholism on parent's, because it has now been declared a disease rather than a behavioral problem. Studies show that when ACOAs use positive coping mechanisms, it is related to more positive results. When an ACOA approaches their issues, rather than avoids them, it often relates to having a positive outlook. Studies have shown that ACOAs and COAs have more compulsive behaviors that may cause the need for higher achievement. Some ACOAs have shown that the only way to survive is to fend for themselves. This causes a sense of independence that helps them become more self-reliant. Because they perceive that independence and hard work as necessary, ACOAs develop a sense of survival instinct.

Implications for Counselors

Counselors serving ACOAs need to be careful to not assume that the client's presenting problems are due solely to the parent's alcoholism. Exploring the ACOAs life events, such as the number of alcoholic parents, length of time the client lived with the alcoholic parent, past interventions, and the role of extended family may help in determining what the correct method of intervention may be.

Many factors can affect marital and/or parenting difficulties, but there has not been any evidence found that can link these issues specifically to ACOAs. Research has been conducted to try to identify issues that arise when someone is a COA. It has been hard to isolate these issues solely to the fact that the child's parents are alcoholics. Other behaviors need to be studied, like dysfunctional family relationships, childhood abuse and other childhood stressors and how they may contribute to things like depression, anxiety and bad relationships in ACOAs.

Counselors serving ACOAs can also help by working on building coping mechanisms such as creating meaningful relationships with other non-alcoholic family members. Having other family members who are supportive can help the ACOA feel like they are not alone. Counselors can also provide some psycho-education on alcoholism and its effects on family members of alcoholics. Research shows that ACOAs feel less like blaming their parents for their alcoholism after learning that alcoholism is a disease, rather than a behavior.

Pregnancy

Prenatal alcohol-related effects can occur with moderate levels of alcohol consumption by non-alcoholic and alcoholic women. Cognitive performance in infants and children is not as impacted by mothers who stopped alcohol consumption early in pregnancy, even if it was resumed after giving birth.

An analysis of six-year-olds with alcohol exposure during the second-trimester of pregnancy showed lower academic performance and problems with reading, spelling, and mathematical skills. 6% of offspring from alcoholic mothers have Fetal Alcohol Syndrome (FAS). The risk an offspring born to an alcoholic mothers having FAS increases from 6% to 70% if the mother's previous child had FAS.

People diagnosed with FAS have IQs ranging from 20–105 (with a mean of 68), and demonstrate poor concentration and attention skills. FAS causes growth deficits, morphological abnormalities, mental retardation, and behavioral difficulties. Among adolescents and adults, those with FAS are more likely to have mental health problems, dropping out or be suspended from schools, problems with the law, require assisted living as an adult, and problems with maintaining employment.