Ageing and mental retardation

Depression is more common among persons with an intellectual disability (ID) than the general population, and may be expected to increase with age just as in the general population. However, little is known about depression among older adults with ID. The literature has questioned the use of standard diagnostic criteria for depression among both older adults and persons with ID, and behavioural depressive equivalents have been suggested. This study uses the interRAI ID assessment instrument to investigate the relationship between standard diagnostic criteria for depression, depressive equivalents and a diagnosis of depression among older and younger adults with ID in community and institutional settings in Ontario, Canada. Items in the interRAI ID assessment instrument that were representative of The Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV) criteria and depressive equivalents were examined among persons with ID in institutional (census-level data) and in community-based (sample) residential settings. Bivariate logistic regression was used to examine the relationship between depressive symptoms and a diagnosis of depression. Descriptive statistics were used to examine the prevalence of depressive symptoms among those who did not have a diagnosis of depression. The results indicate that DSM-IV diagnostic criteria and depressive equivalents were significantly related to a diagnosis of depression among older and younger adults with ID, and that both types of symptoms were exhibited by a non-trivial proportion of individuals without a diagnosis of depression. The depression rating scale embedded in the interRAI ID is helpful in identifying older adults at risk of depression. Contrary to other studies, few significant differences were found in depressive symptoms by age.

Objectives:There are few studies on epilepsy and psychopathology in people with intellectual disability (mental retardation) despite epilepsy prevalence rates that are thirty times higher than in the general population. The...

Editorial: Introduction to Special Section on Evidence-Based Practices for Persons With Intellectual and Developmental Disabilities

PART I: FOUNDATIONS.- Epidemiology and Etiology of Mental Retardation.- The Autism Spectrum.- Cerebral palsy.- Epilepsy in People with Mental Retardation.- Pediatric Brain Injury.- Behavioral Effects of Genetic Mental Retardation Disorders.- Social Acceptance and Attitude Change: Fifty Years of Research.- PART II: DISABILITY SERVICES.- Evaluating Developmental Disabilities Services.- Educational Service Interventions and Reforms.- Psychological Services for Older Adults with Intellectual Disabilities.- Residential and Day Services.- Behavioral-Clinical Consultation in the Developmental Disabilities: Contemporary and Emerging Roles.- Advocacy and Litigation in Professional Practice.- PART III: ASSESSMENT AND DIAGNOSIS.- Intellectual Assessment and Intellectual Disability.- Adaptive Behavior.- Psychosocial and Mental Status Assessment.- Functional Behavioral Assessment in Practice: Concepts and Applications.- Psychoeducational Assessment.- Developmental and Behavioral Screening.- Forensic and Psychosexual Assessment.- Family Assessment and Social Support.- PART IV: PREVENTION AND TREATMENT.- Science to Practice in Intellectual Disability: The Role of Empirically Supported Treatments.- Early Intervention: Background, Research Findings, and Future Directions.- The System of Early Intervention for Children with Developmental Disabilities: Current Status and Challenges for the Future.- Stereotypy, Self-injury, and Related Abnormal Repetitive Behaviors.- Psychopathology Among People with Developmental Delays - Assessment and Treatment.- Aggression in Persons with Intellectual Disabilities and Mental Disorders.- Speech and Language Deficits in Children with Developmental Disabilities.- Functional Skills Training for People with Intellectual and Developmental Disabilities.- Social Skills Training for Children with Intellectual Disabilities.- Vocational Skills and Performance.- Sex Offending Behavior.- Pharmacotherapy.- PART V: ETHICAL ISSUES.- Ethical Issues in Clinical Services and Research.- Ethics and Values in Behavioral Perspective.

Although the coding of mental retardation as underlying cause of death has been recognised by previous researchers as erroneous, factors influencing this inaccuracy have not been sufficiently analysed. This study explores the effects of diagnostic ambiguity on risk of mental retardation being coded as underlying cause of death on US death certificates from 2004. Utilising all US death certificates from 2004 that included a cause of death code for mental retardation, logistic regression analysis provided estimates of the likelihood of having mental retardation erroneously coded as the underlying cause of death. Estimators used to measure ambiguity included the number of multiple causes of death, the place of death, and ICD-10 diagnostic Chapter codes. A total of 2278 US death certificates from 2004 included a cause of death code for mental retardation. Of these death certificates, 20% erroneously coded mental retardation as the underlying cause of death. Reflecting the negative impact of diagnostic ambiguity on death certificate coding accuracy, mental retardation was more likely to be coded as underlying cause of death for decedents who: (1) had a death certificate that provided less information on co-morbid disease processes; (2) died in an outpatient or emergency room setting; or (3) had either abnormal symptomatology or death by injury, accident or other external cause. Findings from this study, as well as prior research, demonstrate that attempts to understand mortality trends for this population must attend to frequent underlying cause of death coding errors which threaten accuracy of cause of death data. Furthermore, inquiry is warranted into the impetus behind US death certificate coding policy that continues to allow the erroneous coding of 'death by mental retardation'.

The objectives of this study were to describe the reported dentate status and complete denture use of older people with intellectual disability (ID) and compare with those of older people in the general population in Ireland. The first wave of the Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA) study provides opportunity to measure edentulism and complete denture use in a nationally representative sample of older people with ID in Ireland. Data drawn from the first wave of IDS-TILDA were matched using propensity score matching with data from The Irish Longitudinal Study on Ageing (TILDA), a study among older adults in Ireland. All IDS-TILDA variables showing significant association (P < 0.05) with edentulism were entered into a regression model to identify predictors of edentulism. The proportion of the 478 IDS-TILDA participants with no teeth was higher (34.1 percent) than the proportion of participants with no teeth in the 478 matched TILDA participants (14.9 percent). Only age was predictive of edentulism among older adults with ID. Edentulism was prevalent earlier for those with ID. Notably, 61.3 percent of edentulous older people with ID were without dentures. Older people with ID are more likely to be edentulous than those without ID in Ireland and when they lose their teeth, they are unlikely to use dentures. This suggests a need for targeted measures to maintain the teeth of this group and, in the short term, the provision of replacement teeth in this population, where indicated.

People with intellectual disabilities (IDs) die at younger ages than the general population, but nationally representative and internationally comparable mortality data about people with ID, quantifying the extent and pattern of the excess, have not previously been reported for England. We used data from the Clinical Practice Research Datalink database for April 2010 to March 2014 (CPRD GOLD September 2015). This source covered several hundred participating general practices comprising roughly 5% of the population of England in the period studied. General practitioner (GP) records identified people diagnosed by their GP as having ID. Linked national death certification data allowed us to derive corresponding mortality data for people with and without ID, overall and by cause. Mortality rates for people with ID were significantly higher than for those without. Their all-cause standardised mortality ratio was 3.18. Their life expectancy at birth was 19.7 years lower than for people without ID. Circulatory and respiratory diseases and neoplasms were the three most common causes of death for them. Cerebrovascular disease, thrombophlebitis and pulmonary embolism all had standardised mortality ratios greater than 3 in people with ID. This has not been described before. Other potentially avoidable causes included epilepsy (3.9% of deaths), aspiration pneumonitis (3.6%) and colorectal cancer (2.4%). Avoidable mortality analysis showed a higher proportion of deaths from causes classified as amenable to good medical care but a lower proportion from preventable causes compared with people without ID. International comparison to areas for which data have been published in sufficient detail for calculation of directly standardised rates suggest England may have higher death rates for people with ID than areas in Canada and Finland, and lower death rates than Ireland or the State of Massachusetts in the USA. National data about mortality in people with ID provides a basis for public health interventions. Linked data using GP records to identify people with ID could provide comprehensive population-based monitoring in England, unbiased by the circumstances of illnesses or death; to date information governance constraints have prevented this. However, GPs in England currently identify only around 0.5% of the population as having ID, suggesting that individuals with mild, non-syndromic ID are largely missed. Notably common causes of death suggest control of cardiovascular risk factors, epilepsy and dysphagia, management of thrombotic risks and colorectal screening are important areas for health promotion initiatives.

In 2004, when I first started to investigate the history of the learning disability construct, I quickly found that the available literature on the topic fell into two categories, valid historical scholarship and celebrationist narratives. There were a small number of serious historical works by Carrier (1983, 1986, 1987) and Franklin (1987, 1994), who examined the growth of the learning disability diagnosis as a political and scientific development over many decades.I framed my own research in the tradition of Franklin (1987, 1994) and Carrier (1983, 1986, 1987), upholding the standards of research methodology and critical analysis set by historians (e.g., Danto, 2008; McDowell, 2002). My goal has been to determine where this notion of learning disability came from and how it grew in the work of many scientists over time. I have assumed neither that learning disability is a correct way of understanding the learning difficulties of some children nor that this construct was built as some sort of farce. I view the construct as a historical product, an idea cultivated through scientific practices and theories over generations of research.My research efforts resulted in a book entitled The Incomplete Child: An Intellectual History of Learning Disabilities that chronicled the scientific ideas and practices that brought about the learning disability construct (Danforth, 2009). It is a story of multiple lines of intellectual traditions conflicting and melding, of pre-WWII German holistic science blending with Chicago School functionalism and the environmentalism of the Iowa Child Welfare Research Station.In addition, I have written a recent series of articles, including the Intellectual and Developmental Disabilities piece that I co-authored with Laura Slocum and Jennifer Dunkle. In these historical articles I addressed topics ranging from the pronounced social class bias of learning disability researchers of the 1960s and 1970s (Danforth, in press, a) to the 1970s epistemological shift toward objectivism (Danforth, in press, b).The Mather and Morris (2011) response paper belongs to the celebrationist category of historical writing that does not meet the standards of methodological rigor and critical analysis set by professional historians. This paper continues a professional line of insider accounts, self-congratulatory, poorly researched historical overviews written by special educators that celebrate the field and its pioneers (e.g., Cruickshank & Hallahan, 1981; Hallahan & Mercer, n.d.; Hallahan & Mock, 2003; Wiederholt, 1974). These works, although often informative, are overwhelmingly acritical. The authors fail to ask serious and troubling questions about the development of the field and the social impact of the ideas in the field. The purposes and the work in the field are lauded without the kind of rigorous scrutiny that historians apply to their subject matter.In their paper Mather and Morris's (2011) attempt to preserve "the legacy that Dr. Samuel A. Kirk left behind" (p. 118). Their primary goal is to perpetuate a purified narrative of a man living, thinking, and acting without contradictions and errors, without moral uncertainty and fallibility.The truth of the matter is that Sam Kirk was far from clear and definitive in his handling of the learning disability construct. In fact, he articulated 16 substantively different versions of the learning disability construct.I devote an entire chapter in my 2009 book to this issue. In this short rejoinder, I briefly illuminate Kirk's multiple contradictory articulations of the concept of learning disability between 1960 and 1984. Then I probe for possible lessons we might draw from Kirk's inconsistencies.In the course of my historical research, I examined every published work that Kirk ever authored or co-authored. Further, I conducted a thorough exploration of his archival materials—many boxes of personal papers such as letters, notes, unpublished presentations—stored at the University of Illinois, Urbana, which allowed me to gather many speeches to professional groups that were never published.Archival research is considered a foundational method of doing historical research. I note that Mather and Morris (2011) did not reference the extensive Kirk archives, suggesting that they took a highly problematic short-cut. I gathered documented records of 18 professional speeches and published writings in which Kirk offered a complete description of the learning disability concept between 1960 and 1984.In order to focus on the actual ideas used to build the learning disability construct, I have identified 15 separate conceptual components that Kirk used and reused over the years. Each component was a semantic building block, a single meaningful element that made a substantive contribution to the larger definition of the disorder.Table 1 presents the 15 conceptual components present in each of the 20 articles or speeches that Kirk made between 1960 and 1984. The components utilized in describing the learning disability concept are labeled with the letters A through O.Components A through C involved etiological theories that posited a causality for the learning difficulty.Components D through I were exclusionary factors, reasons for the learning difficulty that, if present, indicated that the problem was not a learning disability.Components J through N described the comorbidity of learning disability with other childhood disorders. J represents a high level of correlation between learning disability and emotional or behavioral disturbance, such that the two disorders were understood to be constitutionally linked. Components K through M indicate a co-occurrence of distinct disorders. Learning disability and each disorder could co-occur to create what Kirk called a "double handicap" (Kirk, 1967a), but the two impairments were framed as essentially unrelated.Component N involved Kirk's attempt to distinguish between levels of mental retardation in relationship to the learning disability diagnosis. Due to the general and total nature of the intellectual deficit, severe mental retardation was understood to be a disorder quite unlike a learning disability; but mild mental retardation, he sometimes claimed, proved to be only a learning disability concealed behind a diagnostic disguise. Proper educational treatment would bring to light the concealed mental assets, the hidden potentials, in order to demonstrate when mild mental retardation was actually a learning disability.O proposed that students with learning disabilities required a special education program consisting primarily of diagnostic–remedial instruction.Of the 18 complete articulations of the disorder, only two pairs (2, 3 and 15, 17) were completely consistent with one another. The record of complete conceptualizations consists of 16 distinct delineations of the disorder over 24 years. Simply put, Kirk devised 16 variations of the learning disability construct.As Kirk worked in the 1960s to promote acceptance of the new learning disability construct, he repeatedly tried to explain how it related to the older, more established, and greatly trusted classification of children with mental retardation. Kirk's seemingly endless struggle to make this relationship clear is a frustrating tale of theoretical ambiguities and rhetorical miss-steps.In early 1963, separated only by 3 months, Kirk delivered two remarkably different speeches. In January, he spoke to a small conference of brain injury researchers at the University of Illinois, a group that included Newell Kephart, Helmer Mykelbust, and Joseph Wepman. At the Chicago meeting of neurological scientists, he said that learning disability refers toIt was a disorder of the psychological processes with possible etiologies of neurological damage or emotional disturbance. Mental retardation was listed among the excluded conditions.Later in the same presentation, however, Kirk appeared to backtrack on this, stating that learning disability "does not refer to most mentally retarded children since the discrepancy between their ability and their achievement is not great" (Kirk, 1963a, pp. 49–50). His frequent use of the modifiers generalized and most muddied up his assertion that mental retardation was an exclusion.Latour and Woolgar (1979) called words such as these "grammatical modalities" that operate as "an expression of the weight of a statement" (p. 84), a register of factual status. A modality can be used to either increase or decrease the degree of rhetorical facticity. Similarly, linguists use the term hedge to describe a word or phrase that effectively dilutes the certainty, authority, or truth value of a statement. Lakoff (1972) defined a hedge as language "whose job it is to make things fuzzier" (p. 195).Kirk demoted the truth value of his statements, creating some room for doubt or alternative interpretation. Perhaps children whose mental retardation was not "generalized" could also have a learning disability.Three years later, in 1966, he would more fully assert that very claim. If a child with mental retardation "has discrepancies among abilities, or if he has special abilities and marked disabilities, he could be classified as a child with a learning disability as well as overall mental retardation" (Kirk, 1966, p. 2). One could have a generally depressed profile of intellectual ability that still included significant gaps between high and low areas of functioning. He would articulate this same notion of possible co-morbidity of mental retardation nine times between 1963 and 1984 (see Table 1).In the second of Kirk's 1963 speeches, speaking to a very different audience of parents and advocates, he presented a definition of learning disabilities that differed dramatically from his statement to the gathering of scientists:He dropped all possible etiologies of the disorder, including cerebral injury and emotional disturbance.In this revision, the phrasing concerning mental retardation constituted an unequivocal exclusion. Contrary to what Kirk had suggested with the modifiers "most" and "generalized" a few months earlier, a child with mental retardation could not also have a learning disability.It seems that Kirk's presentation to the conference of parent advocates was, at least to some extent, a case of telling the audience what they wanted to hear. His presentation distanced learning disability from the highly stigmatized category of mental retardation. He avoided any discussion of the causes of the learning problem. If he had used any of the standard etiologies (e.g., brain injury, flawed genetic inheritance, or deficient environmental stimulation), the many parents in the audience might have squirmed at the suggestion of blame.Quite likely, Kirk felt pressured by parents to make certain statements in his speech. He later admitted to having mixed feelings about providing a definition of learning disability at the conference. He was wary about adding yet one more diagnostic label of questionable pedagogical value to the professional compendium (Kirk, 1976). During the speech, right before providing a definition for learning disability, he professed to the audience his strong reluctance to do so.Kirk invested far more time and words attempting to convince the listeners to disregard disability definitions than actually offering a definition of learning disability. Later, he recalled that "several [parents] approached me with the admonition that they needed help in the selection of a name for their proposed national organization" (Kirk, 1976, p. 255). Accompanied by words of caution and even mild protest, Kirk gave the parents what they wanted.What we find in this historical analysis is that Samuel Kirk is not a purified icon or an idealized figure gilded in a glorious legacy. We view him as a real person, someone attempting to deal quite awkwardly with too many concepts, constraints, and pressures. As the most famous special educator in the United States during the period of rapid growth in the years immediately prior to and following the passage of P.L. 94–142, Kirk was a political actor tugged in every possible direction. His scattered and often contradictory words left a zigzag trail that attests not only to the "religious revival" (Frierson, 1976, p. 139) emotional tone of the early learning disabilities movement. It also indicates just how difficult it is to use language to pin down an authoritative concept once and for all.I do not believe that Samuel Kirk needs defending. The importance of his contributions to the field of special education is undeniable. In the narrative of the growth of American special education in the latter half of the 20th century, Kirk is the clear hero.Our more practical challenge is to draw useful lessons for today from Kirk's contradictions. Although he was a staunch proponent of the idea that all children can learn, on one spring day in 1967, in a speech at the University of Minnesota, he contradicted his usual message. He used mental retardation as a contrasting foil, a less educable population, in his effort to explain the intellectual capacities of children with learning disabilities (Kirk, 1967b).What does it mean to us when a special education hero stumbles?One possible lesson concerns the cultural pervasiveness of an ugly politics of disability that punishes those deemed furthest from notions of "normal." Even Kirk—even the great Kirk—slipped into this quagmire of disability politics, pushing down on mental retardation in order to elevate learning disability as a disorder likely to respond positively to intervention.In 1967, just as today, a cruel political discourse that devalues persons with mental retardation labels was readily available and too-often employed, even by well-known educators and psychologists. When Kirk praised the educational potential of learning disability in contrast to that of the lesser mental retardation, he stepped into a political pothole that was not of his invention (Kirk, 1967b). He found it nonetheless. He found it quite easily because it was conventional thinking about persons with mental retardation.Kirk's stumble may tell us that the cruel politics of disability that diminishes persons with the mental retardation label (or intellectual disability in current terms) to the bottom of the social hierarchy is not completely divorced from the intellectual and practical traditions of the field of special education. Certainly, the modern American field of special education was founded on Kirk's idea that students conventionally thought to have little or no educational potential deserve public school instruction. But the field, like Kirk, is filled with contradictions.The contribution of the field of special education to the political devaluation of students with disabilities in the schools has been the subject of concern among many scholars (e.g., Brantlinger, 2006; Harry & Klingner, 2006; Ware, 2004). Illuminating the politics of disability in the schools and combating social injustice requires that we honestly and fully acknowledge how standard special education beliefs and practices can operate to stigmatize and isolate children. Toward this end, we should devote less energy to the perpetuation of idealized historical legacies that avoid the unsavory and problematic. We should expend far more energy confronting the cultural devaluation of children with disabilities in our schools and communities.

Th e history of services to and treatment of persons with intellectual disabilities could hardly be perceived as “positive.” Pervasive maltreatment and misunderstanding of persons with intellectual defi cits (e.g., see Bierne-Smith, Patton, & Kim, 2006; Braddock, 2002) was dominant. Persons with intellectual disabilities were oft en viewed as deviant and undesirable, and even demonized. Historically, isolation from the community and institutionalization were the primary modes of treatment. Persons with mental retardation were oft en in long-term institutional settings, oft en with horrifi c living situations. Blatt and Kaplan’s (1966) classic Christmas in Purgatory, a collection of photographs from a state institution for persons with mental retardation, dramatically portrayed the inhumane and harsh conditions of a large state institution. Children with intellectual disabilities were oft en denied school entrance. If they were provided a school program, it was oft en in a “special school” located away from other school buildings or in segregated classrooms. Th ere was little interaction with their non-disabled peers. A fi nal introductory note is that “Intellectual Disabilities” is now the preferred term for mental retardation. Th e American Association on Mental Retardation was re-named the American Association on Intellectual and Developmental Disabilities in 2007. Th e two terms will be used interchangeably throughout this chapter.

Research of health outcomes in older autistic adults (≥45 years) is concerningly scarce, and little is known about whether intellectual disability and sex affect the health outcomes of this population. The aim of this study was to investigate the association between autism and physical health conditions in older adults and to examine these associations by intellectual disability and sex. We conducted a longitudinal, retrospective, population-based cohort study of the Swedish population born between Jan 1, 1932, and Dec 31, 1967, using linked data from the nationwide Total Population Register and the National Patient Register. We excluded individuals who died or emigrated before the age of 45 years, or with any chromosomal abnormalities. Follow-up started at age 45 years for all individuals, and ended at emigration, death, or Dec 31, 2013 (the latest date of available follow-up), whichever was soonest. Diagnoses of autism, intellectual disability, 39 age-related physical conditions, and five types of injury (outcomes) were obtained from the National Patient Register. For each outcome, we calculated 25-year cumulative incidence and used Cox models to estimate hazard ratios (HRs). All analyses were repeated separately by intellectual disability and sex. Of 4 200 887 older adults (2 063 718 women [49·1%] and 2 137 169 men [50·9%]) in the study cohort, 5291 (0·1%) had a diagnosis of autism recorded in the National Patient Register. Older autistic adults (median follow-up 8·4 years [IQR 4·2-14·6]) had higher cumulative incidence and HRs of various physical conditions and injuries than their non-autistic counterparts (median follow-up 16·4 years [8·2-24·4]). In autistic individuals, the highest cumulative incidence was observed for bodily injuries (50·0% [95% CI 47·6-52·4]). Conditions that autistic adults were at higher risk of than were non-autistic adults included heart failure (HR 1·89 [95% CI 1·61-2·22]), cystitis (2·03 [1·66-2·49]), glucose dysregulation (2·96 [2·04-4·29]), iron deficiency anaemia (3·12 [2·65-3·68]), poisoning (4·63 [4·13-5·18]), and self-harm (7·08 [6·24-8·03]). These increased risks mainly persisted regardless of intellectual disability or sex. Our data indicate that older autistic adults are at substantially increased risk of age-related physical conditions and injuries compared with non-autistic adults. These findings highlight the need for collaborative efforts from researchers, health services, and policy makers to provide older autistic individuals with the necessary support to attain healthy longevity and a high quality of life. Swedish Research Council, Servier Affaires Medicales. For the Swedish translation of the abstract see Supplementary Materials section.

Noniron deficiency microcytic anemia, dysmorphic features, and intellectual disability: Diagnostic clues for α-thalassemia/mental retardation associated with chromosome 16 syndrome

BackgroundStudies on avoidable mortality in adults with intellectual disabilities are limited, as are studies on causes of death.ObjectivesWe aimed to quantify mortality rates, and causes, and identify factors (i.e., age,...

Byline: B. Chavan, Abhijit. Rozatkar According to the Census 2001, [sup][1] there are 21 million people with disabilities in India who constitute 2.13% of the total population. In contrast, the National Sample Survey Organization (NSSO) estimated that the number of persons with disabilities in India is 1.8% of the Indian population; [sup][2] of which 75% of persons with disabilities live in rural areas, 49% of them are literate and only 34% are employed. Both the surveys included the persons with visual, hearing, speech, locomotor, and mental disabilities, but the distribution in each category according to the two surveys differs drastically. However, experts working in the field of developmental disabilities feel that prevalence of mental disability is much higher. [sup][3] Intellectual disability (ID) is characterized by significant impairment in cognitive and adaptive behavior. The term used to describe this condition has gone under constant change over the years due to social and political compulsions. The main reason to search for a new term is to find a least stigmatizing terminology. Thus, mental retardation, which was in use world over till late 20 [sup]th century, has now been replaced with ID in most English speaking countries. Diagnostic and Statistical Manual 5 [sup]th Revision (DSM-V) has replaced it with ID and the much anticipated 11 [sup]th revision of International Classification of Disease is likely to do so. [sup][4],[5] The history of ID has passed through a very turbulent phase and can be briefly summarized under: i) Pre-industrialization phase: From the dawn of civilization to the beginning of industrialization period, people born with "abnormal" physiognomy were treated with fear or ridicule (and perhaps continue to do so in many societies). ii) Industrialization phase: Although industrial revolution is associated with increasing wealth and productivity, it also brought in many ill effects. Migration to bigger cities led to development of slums, poverty, diseases, and crimes. Families started valuing those with vocational ability and started neglecting members who were not able to work. The individual who had low intelligence were left out and were labeled as feeble-minded, degrading, and stigmatizing. iii) Humanitarian approach: In 1846, Dr Samuel Gridley Howe from Boston persuaded Massachusetts Legislature to appoint a commission to inquire into the condition of 'idiots'. After survey and close study, he for the first time observed, "These are the proper subjects of education, they can be taught to do some kind of labor and they can be made self-sufficient". [sup][6] It led to many state run schools for these persons. However, these schools were a failure because Howe and his fellows (Sequin and Wilbur) were too optimistic, unrealistic in expectations as they expected to restore all 'idiots' to normal functioning. iv) Demonology of the defectives: The scientific developments of Darwinism, sociological approach, Mendelian theory of genetics, and Binet psychometric tests advocated, directly or indirectly that feeble minded individuals, who could be easily identified and quantified, are risk to the society. Thus, the society started thinking ways to prevent feeble mindedness from occurring and working on ways how to control those in whom it did occur. The segregation seemed to be the best method where feeble minded could be cheaply and wisely cared for along with prevention and societal protection. v) Period of John F Kennedy: In 1963, based on recommendations of President's Panel on Mental Retardation, JF Kennedy made a speech to the Congress of United States and asked for new resources to address the needs for people with mental retardation. Soon, virtually every state launched special educational programs for these persons. [sup][6] Currently, the term ID is being used instead of mental retardation. This transition in terminology is supported by organization like the American Association on Intellectual and Developmental Disabilities (AAIDD), International Association for the Scientific Study of Intellectual Disabilities (IASSID), and President's Committee for People with Intellectual Disabilities. …

People with an intellectual disability (ID) have more complex and different patterns of health care needs than the general population. They experience a greater burden of multi-morbidity, high levels of undetected and unmanaged health issues, and premature mortality than the general population. Primary care has a key role in the health care of people with an ID. Currently, very little is known about the consultation type and length, problems managed, and how general practitioners (GPs) manage these problems for people with an ID compared with the general population. This information would provide valuable insights into how GPs are achieving the health guidelines and facilitating people with an ID to achieve the highest attainable standard of health. A secondary analysis of data was collected from January 2003 to December 2012 from the Bettering the Evaluation and Care of Health (BEACH) programme. Consultation type, consultation length in minutes, problem(s) managed during the consultation, medications, treatments provided, and referrals made, pre and post age-sex standardisation, at all GP encounters with people identified in the encounter record as having an ID ('ID' encounters, n=690) were compared with those at 'non-ID' encounters (n=970641). Statistical significance was tested with 95% confidence intervals. This study identified significant differences in consultation types, consultation length, problem(s) managed during the consultation, medications, treatments provided, and referrals made at 'ID' encounters compared with 'non-ID' encounters. 'ID' encounters had more indirect encounters, longer consultations, more problems managed, but an under management of common health conditions in people with an ID. Administrative rather than medically related actions dominated clinical treatments for people at 'ID' encounters, and they received fewer procedural treatments, referrals to specialists, and medications compared with those at 'non-ID' encounters. The significant differences in consultations, problems identified and managed suggest that GPs may require additional support to (1) identify and manage common medical conditions experienced by people with an ID; (2) manage the increased time required for consultations; and (3) directly consult with people with an ID. Further research is required to determine why GPs managed problems in a significantly different way for people with an ID.

The study of premature deaths in people with intellectual disability (ID) has become the focus of recent policy initiatives in England. This is the first UK population-based study to explore cause-specific mortality in adults with ID compared with the general population. Cause-specific standardised mortality ratios (SMRs) and exact 95% confidence intervals were calculated by age and sex for adults with moderate to profound ID living in the unitary authorities of Leicester, Leicestershire and Rutland, UK, between 1993 and 2006. Causes of death were also studied to determine how often ID and associated conditions, such as Down syndrome, were mentioned. A total of 503 (17% of population) adults with ID died during the 14-year study period (30 144 person-years). Relatively high cause-specific mortality was seen for deaths caused by congenital abnormalities (SMR = 8560), diseases of the nervous system and sense organs (SMR = 1630), mental disorders (other than dementia) (SMR = 1141) and bronchopneumonia (SMR = 647). Excess deaths were also seen for diseases of the genitourinary system or digestive system, cerebrovascular disease, other respiratory infections, dementia (in men only), other circulatory system diseases (in women only) and accidental deaths (in women only). Two-fifths (n = 204; 41%) of deaths recorded in adults with ID mentioned ID or an associated condition as a contributing cause of death. Strategies to reduce inequalities in people with ID need to focus on decreasing mortality from potentially preventable causes, such as respiratory infections, circulatory system diseases and accidental deaths. The lack of mention of ID on death certificates highlights the importance of effective record linkage and ID reporting in health and social care settings to facilitate the government's confidential inquiry into causes of death in this population.