Mental disability

Articles Mental retardation and mental retardation overlap thematically. Help me to better differentiate or merge the articles (→  instructions ) . To do this, take part in the relevant redundancy discussion . Please remove this module only after the redundancy has been completely processed and do not forget to include the relevant entry on the redundancy discussion page{{ Done | 1 = ~~~~}}to mark. HHE99 ( discussion ) 13:50, Jan. 31, 2016 (CET)

This article or paragraph presents the situation in Germany . Help us to describe the situation in other countries.

Classification according to ICD-10
F70	Mild intellectual disability (IQ 50-69)
F71	Moderate intellectual disability (IQ 35-49)
F72	Severe intellectual disability (IQ 20–34)
F73	Severe intellectual disability (IQ below 20)
F74	dissociated intelligence (clear discrepancy of at least 15 points between language and action IQ)
F78	Other intellectual disabilities (assessment of intellectual disability not possible)
F79	Unspecified intellectual disability (intellectual disability cannot be classified)
ICD-10 online (WHO version 2019)

The term mental handicap (also “mental retardation” and “mental retardation”) describes a persistent state of clearly below average cognitive abilities of a person as well as the associated restrictions of his emotional life and behavior as well as motor skills.

However, a clear and generally accepted definition is difficult: Medically oriented definitions speak of a “reduction or reduction in the maximum achievable intelligence ”. The International Statistical Classification of Diseases and Related Health Problems (ICD-10) also describes this phenomenon as “ intellectual disability” (F70–79). According to this - purely in terms of intelligence - an intellectual disability can be understood as an increase and expansion of a learning disability . Instead of intelligence, other definitions focus more on the interaction of the person concerned with their environment.

The term must be distinguished from similar phenomena. Age- or illness-related loss of previously controlled skills (and thus also of intelligence) is called dementia . In the case of permanent impairments due to mental or neurological illnesses, which are primarily represented by thought disorders with (largely) preserved intelligence, one speaks of a mental disability . In general, mental, physical and mental disabilities can occur independently of one another or also in combination .

Diagnosis and differential diagnosis

A diagnosis of intellectual disability often refers to the measurement of significant intellectual disability using standardized intelligence tests . An intelligence quotient (IQ) in the range 70 to 85 is below average; in this case one speaks of a learning disability. An IQ below 70 then determines the diagnosis of intellectual disability. A further subdivision of this area is considered obsolete by some authors , since there are no measurement methods that produce valid and reliable results with the necessary selectivity.

If it is not possible to carry out an intelligence test, for example because of a physical disability or a behavioral disorder , other tests are carried out (for example, independent eating and drinking, work samples, independent dressing). In the area of ​​the lowest intelligence performance, which occurs in severe clinical pictures, adhesions in the brain or parts of the brain destroyed during the war, the ability to be conditioned to certain stimuli was used diagnostically in the past . For example, patients formerly referred to as “imbezil” could be conditioned with positive stimuli or regular habits (sweets, meal times), whereas with an IQ below 20, only aversive stimuli could be associated with an avoidance reaction . Clinically, the diagnosis was mainly used in the sense of a limit specification (e.g. limit debilit), although scaling with point values ​​was also possible. The information therefore lost its value as a distribution function in the lower range and was a purely diagnostic class.

Even today, the attribution of an intellectual disability by measuring intelligence is very controversial. In the meantime, it has given way to an individual case-by-case description as part of a systemic analysis of the human-environment relationships, whereby IQ tests are carried out regularly, but are not (may) be interpreted as the sole value.

Some illnesses or disabilities superficially resemble intellectual disability, but must be differentiated from it in the sense of a differential diagnosis . This is, for example, early childhood autism , psycho-social deprivation (also deprivation syndrome or hospitalism ), dementia or organic brain diseases . The so-called pseudodebility (also: pseudodementia , in adults Ganser's syndrome ) must be distinguished from intellectual disability, because here the cognitive impairment is a conversion symptom. The main distinctions are that the intellectual disability is inherent , that there are no delusional symptoms , and that the social behavior is not autistic .

Symptoms

Most noticeable are the delay in cognitive and intellectual development in childhood, learning difficulties in school and the reduced ability to abstract (such as getting stuck on detail or on the sensually perceived, gullibility). Not only the maximum average intelligence that can be achieved , but in some cases also the ability to adapt and social and emotional maturity are impaired.

A mental disability is often associated with other special features (such as autism , birth defects of the brain , learning disorders, impaired motor skills and language ). It does not necessarily influence the ability to perceive feelings such as joy , anger or suffering (cf. cognitive handicap ), but to some extent the ability to deal with these feelings and to communicate them (verbally) .

The life expectancy of people with intellectual disabilities is, on average, 12 years lower than that of the general population, and frailty occurs earlier. In the opinion of the Catholic University of North Rhine-Westphalia, however, it is not appropriate to treat people with an intellectual disability in facilities for disabled people in times of a pandemic in the same way as senior citizens. While one in five of the 75-year-olds and older in Germany dies of an infection with SARS-CoV-2 , this only applies to 4.5 percent of all adults with a mental disability. Of the under 18-year-olds, only 1.7 percent die. However, the quoted rates are significantly higher than those of the total population under 75 years of age.

Degree of intellectual disability

The ICD-10 classification divides intellectual disability into different degrees. These are:

Mild mental retardation

also slight intellectual disability , early debility , ICD-10 F70

The IQ is between 50 and 69. Those affected have difficulties in school and, as adults, reach an intelligence age of 9 to under 12 years. Many adults can work and have good social relationships.

Moderate intellectual disability

also moderate intellectual disability , early imbecility , ICD-10 F71

The intelligence quotient is between 35 and 49. In adults, this corresponds to an intelligence age of 6 to less than 9 years. There are significant developmental delays in childhood. Most, however, can achieve a degree of independence and acquire adequate communication skills and training. Adults need different levels of support in daily life and at work.

Severe intellectual disability

also severe mental retardation , early imbecility , ICD-10 F72 . The intelligence quotient is between 20 and 34. This corresponds to an intelligence age of 3 to less than 6 years for adults. Since those affected cannot learn to read and write and cannot attend a general school, they attend a school for the practically educable (also special school ), where they receive practical training. Continuous support is needed.

Severe mental handicap

also severe intellectual disability , early idiocy , ICD-10 F73 . The intelligence quotient is below 20. This corresponds to an intelligence age of less than 3 years for adults. The own supply, continence , communication and mobility are severely impaired.

Dissociated intelligence

ICD-10 F74 . There is a clear discrepancy of at least 15 IQ points, for example between language IQ and action IQ.

Other mental retardation

also other intellectual disabilities , ICD-10 F78 . This category should only be used if it is particularly difficult or impossible to assess the intellectual disability with the help of the usual methods because of accompanying sensory or physical impairments, such as in the case of the blind, deaf-mute, severely behavioral or physically disabled people.

Unspecified intellectual disability

also unspecified intellectual disability , ICD-10 F 79 .

The information is insufficient to classify the intellectual disability into any of the above categories.

causes

Baby with typical facial features of the fetal alcohol syndrome , triggered by alcohol consumption during pregnancy: small eyes, smooth philtrum , narrow upper lip

On the one hand , the causes of intellectual disability are endogenous factors that usually have a hereditary basis ( hereditary diseases ) or chromosomal peculiarities such as Down syndrome , Sotos syndrome or the cat's cry syndrome ; Exogenous factors during pregnancy are acquired cerebral damage to the embryo, for example

• Alcohol consumption by pregnant women
• Encephalitis / meningitis
• cretinism
• Malnutrition of the pregnant woman (e.g. due to famine, eating disorders , ritual fasting (e.g. Ramadan ), these lead to an earlier birth and lower birth weight)
• Radioactive irradiation of pregnant women (see also radiation sickness )
• accident
• Lack of oxygen during childbirth

Low levels of vitamin D in the blood may be detrimental to brain performance. This is suggested by data from a US study with 858 participants over 65 years of age. In participants with low vitamin D 25 OH values ​​at the start of the study (below 25 nmol / l), the rate of cognitive impairment was 60% higher after six years than in participants with high values ​​(above 75 nmol / l) and around 31% higher than with sufficient initial values. The most common genetic cause of intellectual disability is Down syndrome. The most common non-genetic cause of intellectual disability is fetal alcohol syndrome , which is triggered or caused by alcohol consumption by the pregnant woman.

Clear causal attributions are sometimes difficult or not possible. In many cases they are - in the form of a “blame” - rather a hindrance or counterproductive for early intervention and support.

genetics

The most common genetic cause of decreased intelligence is Down syndrome with an average frequency ( prevalence ) of around 1: 500. Other chromosomal aberrations can also affect neuronal development. In contrast to hereditary diseases , chromosomal aberrations only arose shortly before in an egg cell of the mother. Hereditary diseases in the narrower sense are rare to very rare mutations that have mostly been transmitted over several generations.

The following is a list of the hereditary diseases that can lead to neural development disorders with reduced intelligence in the newborn.

Surname	Inheritance	frequency	ICD-10	OrphaNet	Affected genes / proteins
Börjeson-Forssman-Lehmann syndrome	X recessive	?	Q87.8	[2]	PHF6
Brunner syndrome	X recessive	?	E70.8 F54	[3]	MAOA ( monoamine oxidase )
Coffin-Lowry Syndrome	X recessive	2 / 100,000	F78.8	[4]	RPS6KA3
Cornelia de Lange Syndrome	X recessive / autosomal dominant	total 1-9 / 100,000	Q87.1	[5]	NIPBL , SMC1A , SMC3
Cri du chat	Partial monosomy on chromosome 5	1 / 50,000	Q93.4	Mental disability. In: Orphanet (Rare Disease Database).
FG syndrome	X recessive	> 1 / 1,000	Q87.8	[6]	BRWD3 , CASK , FLNA , MED12 , UPF3B
Fragile X Syndrome	X recessive	5-9 / 10,000	Q99.2	[7]	FMR1 ( Fragile X Mental Retardation 1 Protein )
FRAXE syndrome	X recessive	1-9 / 1,000,000	-	[8th]	AFF2
Hennekam syndrome	autosomal recessive	below 1: 1,000,000	-	[9]	CCB1
Joubert syndrome	sporadically	over 100 cases	Q04.3	[10]	INPP5E
Lujan-Fryns Syndrome	X recessive	?	F79	[11]	MED12 , UPF3B
Martsolf syndrome	autosomal recessive	under 20 cases	Q87.8	[12]	RAB3GAP2
MASA syndrome	X recessive	1-9 / 100,000	G11.4	[13]	L1CAM
Microcephaly , primary	autosomal recessive	total 2-4 / 100,000	Q02	[14]	ASPM , CDK5RAP2 , CENPJ , CEP152 , MCPH1 , STIL
Gaucher's disease	autosomal recessive	1-9 / 100,000	E75.2	Mental disability. In: Orphanet (Rare Disease Database).	GBA
Mucopolysaccharidosis	Enzyme defects, lysosomal storage disease		E76.0 E76.1 E76.2 E76.3	Mental disability. In: Orphanet (Rare Disease Database).
Nordic epilepsy syndrome , ( neuronal ceroid lipofuscinosis type 8)	autosomal recessive	under 1 / 1,000,000	E75.4	[15]	CLN8
Partington Syndrome	X recessive	under 1 / 1,000,000	-	[16]	ARX
Pierre Robin sequence	different shapes	1-9 / 100,000	Q87.0	Mental disability. In: Orphanet (Rare Disease Database).
Renpenning Syndrome	X recessive	?	-	[17]	PQBP1
Rett syndrome , atypical	dominant	1-9 / 100,000	G40.3	[18]	CDKL5 , FOXG1 , MECP2 , NTNG1
Rubinstein-Taybi Syndrome	autosomal dominant or unknown	1-9 / 100,000	Q87.2	Mental disability. In: Orphanet (Rare Disease Database).	CBP , p300
Sjogren Larsson Syndrome	autosomal recessive	1-9 / 1,000,000	E71.3	[19]	ALDH3A2 ( fatty aldehyde dehydrogenase )
Snyder-Robinson Syndrome	X recessive	11 cases	-	[20]	SMS
Tyrosinemia Type II	autosomal recessive	<1 / 1,000,000	E70.2	[21]	TAT ( tyrosine aminotransferase )
West Syndrome	?	1-9 / 1,000,000	G40.4	[22]	ARX , CDKL5
Williams-Beuren Syndrome	autosomal dominant	1-20,000-50,000	Q78.8	Mental disability. In: Orphanet (Rare Disease Database).
XLAG syndrome	X recessive	?	Q04.0 Q04.3	[23]	ARX
unspec.	X recessive	total 6-9 / 10,000	F78	[24]	ACSL4 , AGTR2 , ARHGEF6 , AP1S2 , ARX , ATP6AP2 , ATRX , CUL4B , DLG3 , FTSJ1 , GDI1 , GRIA3 , HSD17B10 , HUWE1 , I1RAPL1 , IQSEC2 , KDM5C , MAGT1 , MECP2 , OPHN1 , PAK3 , PHF8 , RAB39B , RPS6KA3 , SHROOM4 , SLC9A6 , SOX3 , SYP , TSPAN7 , UPF3B , ZNS41 , ZNS674 , ZNS81
unspec.	autosomal recessive	?	-	[25]	CC2D1A , CRBN ( Cereblon ), GRIK2 , PRSS12 , TRAPPC9 , TUSC3
unspec.	autosomal dominant	?	-	[26]	CDH15 ( Cadherin -15), KIRREL3 , MBD5 , SYNGAP1

see also autosomal recessive primary microcephaly and X-linked mental retardation .

Funding in Germany

In order to support children with an intellectual disability in their development as best as possible, they often complete targeted early support as early as possible . Kindergartens are open to them at the appropriate age , in some places there are integrative facilities or special special kindergartens.

In Germany because the education law a duty schedule it for a visit to a school for all children and young people, compulsory education period is twelve years are also in children and adolescents with intellectual disabilities (including vocational school level). However, this time can be extended by several years due to special circumstances (with expected performance development).

Until the middle of the 20th century, people with an intellectual disability were largely denied the ability to attend an education. Over the years from around 1960, more and more special schools were created . The traditional name of the special school for the mentally handicapped has meanwhile been replaced by other names in the individual federal states . Since the 1990s at the latest, efforts have been made to integrate children and young people with intellectual disabilities into school: they attend regular schools . Compared to other European countries (Scandinavia, Italy, France), which achieve an integration rate of over 80% in some cases, the proportion of pupils with an intellectual disability who go to a special school in Germany is 97%; only 3% receive integrative training.

In the course of the integration movement, adult education for people with intellectual disabilities has also become a reality in many places. In the field of education , mentally handicapped education, as a sub-area of special education or curative education, takes care of the concerns of people with a mental disability.

As a rule, people with intellectual disabilities need texts in simple language for independent orientation , provided they have successfully learned to read .

Work and living situation in Germany

Enabling people with intellectual disabilities to live as autonomously and self-determinedly as possible also includes the requirement for an appropriate working and living situation. With the increasing severity of the disability, however, the need for support in various areas of life grows: mobility , spatial mobility , continence or communication can be impaired up to and including the need for care .

At the latest with the establishment of special workshops for disabled people (WfbM) in the 1960s, there were corresponding jobs in the second labor market across Germany . Increasingly, people with intellectual disabilities are also working in jobs on the primary labor market or in integration companies.

As a rule, people with intellectual disabilities are no longer accommodated in institutions or hospitals, which used to lead to exclusion and regularly to hospitalism . Modern forms of living should only offer the necessary support and encourage self-determination. The possibilities include assisted living in your own apartment or in a shared apartment , dormitory with individual care and assistance, living in foster families (example: Geel ), in integrative villages (example: Protestant Alsterdorf Foundation in Hamburg), or in integrative ones Flat shares (like in Munich).

While a job usually takes place after school, many young adults stay with their original family for many years.

Legal situation in Germany

Even people with intellectual disabilities are not denied the right to participate in public life. There has been no incapacitation , guardianship or infirmity care in Germany since 1992. If there are doubts about the ability to lead an independent life, the competent local court can arrange for the person concerned to be supervised by others.

A criminal responsibility in criminal law , an offense ability and capacity in civil law or act in administrative law are, however, often denied people with intellectual disabilities. Corresponding regulations are contained in Sections 19–21 StGB , Sections 104–113 BGB and Sections 827–832 BGB.

Mental disorders in people with intellectual disabilities

introduction

Problem

It has been proven that mental disabilities are usually associated with mental disorders or mental illnesses. Studies by English authors such as Rutter 1970, Corbett 1979, 1985, Ineichen 1984 and Reid 1980, 1985 show that mental disorders occur four to five times more often in mentally disabled children and adults than in the normal population. Further studies in other countries also confirm a high incidence rate of mental illness in people with intellectual disabilities.

Theories of origin

Explanatory models of mental disorders in the mentally handicapped

The emergence of special psychological problems of the mentally handicapped is examined in terms of developmental psychology, not least because the step from the defect model to the development model has taken place in the previous decades. This new perspective ascribes the possibility of development to mentally handicapped people, whereby the developmental steps, phases and sequences are in no way different from non-handicapped people.

There are different development theories in developmental psychology, all of which are based on the findings of the two great psychiatrists Sigmund Freud and Adolf Meyer . The interaction of both directions can be called psychodynamics.

In addition to psychodynamic aspects, genetic factors, organic properties, neuropsychological states, cultural influences, temperament qualities and developmental patterns of various psychological functions and others also occur in developmental psychiatry. As already mentioned, the investigators in the field of mental impairment of mentally handicapped people use methods against the background of developmental psychiatry. A developmental dynamic perspective includes the psychological impairment that can be caused by incorrect behavior in the social environment.

   biologisches Substrat---Funktionen
               |       \  /     |
               |        \/      |
               |        /\      |
               |       /  \     |
             Umfeld ------- Entwicklung
 (Elemente der entwicklungsdynamischen Betrachtung)

The developmental dynamic model helps to better understand the problems of mentally handicapped people. DOSEN uses a multidimensional model of socio-emotional development to explain the occurrence of mental disorders in the mentally handicapped.

The maturation of the child in the socio-emotional, cognitive and neurophysiological area is dependent on one another. The areas develop in a process that is divided into three phases, i.e. the adaptation phase, the socialization phase and the individual phase. In every phase, i.e. from the first to the third year of life, important functions are developed and essential characteristics acquired.

It is assumed that in the mentally handicapped with mental disorders the cognitive and socio-emotional side do not develop parallel and balanced. The cognitive area develops better than the socio-emotional area. In the case of an unfavorable course of socio-emotional development, ie if a child deviates from normal development in an age-specific phase (adaptation, socialization and individual phase) or stops, according to Menolascino (1970) mental illnesses are the result. Furthermore, a mental disorder can be traced back to an acquired cause. In a group of 730 clinically placed children, 81% were diagnosed with a mental disorder. Her mental illnesses were classified according to the Menolascino diagnostic scheme. A blocked socio-emotional development was determined in 33% of the test persons, a proportion of 26% was assigned to the deviating socio-emotional development and the remaining 22% amounted to acquired mental illness.

Blockage of socio-emotional development

If the socio-emotional development is blocked, the socio-emotional development stops, while the cognitive development continues. If it comes to a standstill in the first adaptation phase, a "primary contact disorder" occurs in the child. A “secondary contact disorder” is when the symptoms of a contact disorder show up after an initial attachment experience.

Divergent socio-emotional development

"Deviating socio-emotional development" means that the child's socio-emotional development progresses, but differs in quality and direction from normal development.

Acquired mental illness

Those affected have acquired a predisposition for a certain deviation at a certain age, which can break out under certain circumstances.

Diagnosis

Psychodiagnostics of mentally disabled patients

The examination of mentally handicapped people with mental illnesses is carried out with the existing instruments of psychiatry and clinical psychology. It includes techniques and methods that are briefly presented here.

In the anamnesis, the patient and his family are asked about the medical history by the examiner. A basic method of psychology for personality development is behavior observation. The examiner can perceive the patient for a certain behavior in a certain situation. A CNS abnormality is particularly common in people who have an IQ below 50. Since a behavioral and mental disorder can be an expression of an organic disorder (e.g. deviation of the CNS), a physical examination must be carried out to determine whether there is a connection between the two disorders. Since the nervous system influences all organic and psychological processes in the body, a neuropsychological examination is also necessary. This is followed by various additional examinations such as x-rays of the skull, EEG, CCT and biochemical blood and urine tests . Psychometric tests are used to examine personality traits. Intelligence is also included and can be determined using so-called intelligence tests. You draw the line between normalcy and intellectual disability. A test person can be classified according to his calculated IQ in a category with a corresponding degree of expression. Learning tests also try to measure the child's cognitive performance. This happens because the child always solves the tasks. After determining the level of performance, the child is helped and then the performance is measured. Its purpose is to determine what and to what extent the child needs help to solve the task. With the help of social and adaptive behavior scales, behavioral processes of the mentally handicapped can be registered in their environment. During the psychiatric examination, the psychiatrist has two methods and means at his disposal that facilitate his research into mental illnesses. These are also used in combination with non-disabled people. Before the psychiatrist conducts tests, he will collect necessary information about his patient through communication and observation. The psychiatrist will arrange the conversation in such a way that the patient is confronted with emotionally charged topics. The patient's reactions are evaluated by the psychiatrist. Finally, the conversation is directed back to relaxed topics and solidarity is conveyed to the patient.

Syndromes

Overview of the most famous syndromes

• Depressive Syndrome
  • Sadness, depression, numbness, joylessness,
  • Disinterest, listlessness,
  • Sleep disorders, eating disorders,
  • physical discomfort,
  • Suicidality,
• Manic syndrome
  • (Dis) euphoria,
  • Drive increase,
  • strong self-esteem,
  • increased spending, "megalomania",
  • low need for sleep,
  • uninhibited flow of speech,
  • Disinhibition,
• Paranoid Hallucinatory Syndrome
  • Delusional ideas,
  • Hallucinations,
  • Spreading, withdrawing or inspiring thoughts,
• Catatonic syndrome
  • Rigidity / arousal,
  • Echolalia,
  • Echopraxia,
  • Movement and posture stereotypes,
• Hypochondriac Syndrome
  • moaning, complaining,
  • scared,
  • precise introspection,
  • Fear of getting sick,
• Anxiety syndrome
  • Anxiety (diffuse or situational),
  • Hyperactivity in these states,
• Obsessive-compulsive disorder
  • repeated thoughts that are felt as pointless and tormenting,
  • Impulses, actions,
• Organic Brain Syndrome
  • Restriction of cognitive functions,
  • Limitation of thinking ability,
  • Orientation problems,
  • Loss of concentration, weakness,
• Delirious syndrome
  • Orientation problems, confusion,
  • motor restlessness,
  • vegetative derailments (sweating ...),
• Conversion Syndrome
  • motor disorders (paralysis),
  • Painlessness, painful conditions

Guiding principles for education and therapy

Educators, therapists and psychotherapists should not stand in each other's way with tasks and goals, but support each other. A common ground has to be found in order to help patients as best as possible. Nine guiding principles serve to support the therapy:

1. Adult Orientation - Adults with intellectual disabilities are often treated repeatedly as children. They are seen as "eternal children" and so do not get the respect they deserve.
2. Subject centering - The therapy should pay attention to the person affected. His wishes must be respected. The disability must not become a mere object of therapy.
3. I-You-Reference - Any therapy should be viewed as a partnership relationship and not as a compulsion (or something similar).
4. Emancipatory principle - the patient should develop independently into an ego-strong person. His wishes and interests should go into his development. Just like any other person, he has his place in society.
5. Assistance and cooperation - the path to independence is the goal. Not the goal in itself.
6. Holistic, integrative principle - the mentally handicapped person must be viewed as a "unit". Every work in pedagogy should be “multi-perspective”.
7. Principle of development conformity - The focus on people is in the foreground: In a situation that is comfortable for the patient, one level more should always be learned.
8. Proximity to life and hands-on learning - the patient should experience both everyday housework and the reality of life outside the living environment in the natural habitat.
9. "Be" - and trust in the resources - Not only learning and improving skills and abilities should be in the foreground, but also a purpose-free and self-determined life. The patient must be given the opportunity to discover his own life.

Intellectual disability and sexuality

Are people with intellectual disabilities in the legal sense capable of action and legal capacity , they may also by marriage a marriage received. Interventions in the sexual self-determination of adults, for example by the staff of homes in the form of preventing any sexual activity of mentally handicapped residents, are not permitted.

Forced sterilization of people with intellectual disabilities (such as during the Nazi era , but also still common in the first decades of the Federal Republic of Germany) has been banned in Germany since 1992 . People are no longer allowed to be sterilized without their consent. This also applies to minors. In the case of people unable to give their consent, their supervisor may only consent under the strict requirements of Section 1905 BGB . If sterilization is to be carried out, an additional sterilization supervisor must be ordered.

Art. 23 Paragraph 1c of the UN Convention on the Rights of Persons with Disabilities requires the member states of the UN to guarantee that "people with disabilities, including children, retain their fertility on an equal footing with others."

Concerns for the future

The concerns, the realization of which is a goal of people with different cognitive disabilities and their families and friends, can be summarized in the guiding principles:

• Social participation instead of care
• Well-considered planning instead of erecting barriers
• Appreciation and respect instead of discrimination
• Integrated participation instead of prenatal selection and social-institutional exclusion

Discussions about the term and the underlying concept

Obsolete names

Insanity and (with congenital forms) oligophrenia (Latin oligophrenia ) are outdated technical terms for a mental handicap or, better, according to current nomenclature , " intellectual disability ". The old terms debility (from Latin debilis , 'awkward, weak'), imbecility (from Latin imbecillus , 'weak, frail') and idiocy (from Greek ἰδιώτης idiotes , 'the one who lives apart , who lives for himself'), also idiotism , denoted different ones Degrees of nonsense. Building on preliminary work by Philippe Pinel , Jean Étienne Esquirol distinguished “idiocy” from dementia at the beginning of the 19th century. According to today's nomenclature, the debility corresponds to a slight (ICD-10F 70), the imbecility to a moderate (F 71) and severe (F 72) and the idiocy to a most severe intellectual disability (F 73). The old terms have completely disappeared from technical jargon. The terms idiocy and debility (less imbecility) found their way into everyday language as swear words and were therefore ultimately no longer usable in technical language due to this negative connotation . The term idiocy is also unsuitable in terms of content, because it only describes small aspects of intellectual disability that were previously wrongly viewed as essential for the disability.

The term feeble-mindedness can still be found in the Criminal Code (StGB) of the Federal Republic of Germany ( Section 20 StGB “ Incapacity for mental disorders”). In the care law , which was only introduced in 1992, the more modern term of intellectual disability is used in § 1896 BGB. The current term “intellectual disability” has not yet found its way into legal texts.

Alternatives to the term “mentally handicapped”, problems of interpretation and classification

The use of language when dealing with people with this disability has also changed significantly. In the 1960s, people still spoke of the “mentally handicapped” or “moronic”. However, since these formulations emphasize the handicap in front of people and thus stigmatize them, the term “people with intellectual disabilities” was later used. This puts people in the foreground and intellectual disability is one of many characteristics. In the GDR , the term was partially replaced by “mental disability” because the psyche was to be underlined in its capacity as a physical function and not understood as a mental, body-independent property. Both terms are still in use, are used as connotatively neutral, but denote slightly different things, because "mental disability" also describes psychiatric clinical pictures that are not or only insignificantly associated with a reduction in intelligence, but impair the person's everyday ability. Pronounced depressive syndromes - through reduced drive, loss of interest and reduced concentration - can hinder learning and performance to such an extent that one speaks of a "depressive pseudodementia", although a "mental" disability according to today's understanding of the term is by no means present.

Perspectives that see disability as a social rather than a personal category have also changed the view of intellectual disability. In 2001 the World Health Organization (WHO) differentiates between causal damage , the resulting impairment of activity , impairment of participation in an area of ​​life or a life situation, and the environmental factors in the physical, social and attitude-related environment. This means that damage or impairment of activity does not necessarily have to lead to social impairment and thus disability.

In the recommendations of the Conference of Ministers of Education and Cultural Affairs of 1994 and 1998, the focus on intellectual development is mentioned as a target area for special educators. Children and young people with an intellectual disability will continue to be used as a term for corresponding pupils ; However, there are occasional names such as children and young people with the need for intellectual development or children and young people with special needs in the area of ​​holistic development .

Alternative term "people with a cognitive disability"

The term cognitive disability is preferred by some authors and increasingly by representatives of various educational directions such as special education , social education or curative education .

The term cognitive disability is preferred to intellectual disability by a number of representatives from literature and teaching because it emphasizes the qualitative difference between mind and brain or between intellectual abilities and cognitive abilities.

So were among the intellectual abilities of humans and the assets, feelings - such as anger , sadness , joy , happiness or even empathy - to express feeling respectively. This range of abilities is normally not impaired at all in people with Down syndrome (trisomy 21), for example , who have previously been assigned the attribute of intellectual disability , which is why the common name appears to its critics as too vague or even discriminatory .

The cognitive abilities affected by a disability , on the other hand , included attention , perception , knowledge , reasoning , judgment , memory and retentiveness , learning , abstraction and rationality .

Opponents of an alternative linguistic regulation argue that the new term also brings blurring - so it concentrates on the abilities of ratio , but, in contrast to the old nomenclature, does not cover aspects of emotional and social maturity that can certainly be affected by intellectual disabilities . The discriminatory effect of the old term is subject to the deterioration in meaning , which would also encompass any new creation after prolonged use and which in turn requires replacement.

The spread of the new term in literature and teaching varies greatly, depending on the author and faculty . While it is most widespread among progressive representatives of special and social education, it is hardly known in the fields of medicine and psychiatry. In the terminology of neurology , on the other hand, one would understand a cognitive disability in the literal sense of the word as the isolated failure of a cognitive function, such as a severe disturbance in memory, such as can be caused by damage to the brain. The term cognitive disability has not yet found its way into everyday language use outside the professional world .

Alternative term "people with a cognitive impairment"

There is a noticeable trend towards generally avoiding the word “disability” and replacing it with the word “impairment”. Accordingly, linguistically, “people with an intellectual disability” would become “people with a cognitive (or mental) impairment”. However, those who speak and write in this way fail to recognize that German social law draws a sharp line between people with and without disabilities. Peter Masuch , President of the Federal Social Court , defended this limit at the 2016 Werkstättentag in Chemnitz : “While [...] people without disabilities can and must help themselves because of the subordinate status of social assistance, people with disabilities need support from fellow human beings and society. “For example, workers in a workshop for disabled people are reliably protected from unemployment , but not people below the statutory retirement age who have been certified to be at least partially employable. The background to Masuch's statement is the intention to keep the group of people who should be able to legally invoke the UN Disability Rights Convention within limits.

Anyone who describes people with a disability as "impaired" or "disadvantaged" is not clarifying whether or to what extent provisions of the Social Security Code are applicable to the persons concerned, since not every, but only permanent and serious impairment is legally considered a "disability". With the term “impairment” (category “durability)” it is not clarified that z. B. People with a fracture that is likely to heal in the medium term (unlike people with a disability) are only temporarily dependent on accessibility, while z. B. People pushing a stroller are not "seriously" affected by revolving doors.

Alternative term "practically imaginable"

In the state of Hesse , a new type of school was officially set up in 1962, the "School for Practically Formable (Special School)". This new type of school not only recognized that people who in all probability will never be able to read, write and do arithmetic also have a right to education, even if this is largely limited to practical skills that the people concerned can learn. At the same time, the choice of terms avoids the word “disability”. The term “practically imaginable” is still common in official language in Hesse today.

Alternative term "people with learning difficulties"

The self-advocacy movement (self-advocacy of disabled people), most strongly represented in Germany by the People First eV association , rejects the expression “intellectual disability”, also because of the discrimination attributed to it, and advocates its abolition. She calls for the term “people with learning difficulties” to be used and thus the difference to people with learning disabilities to be canceled, because there is no such thing as “intellectual disabilities”. The distinction between what is commonly referred to as "intellectual disability" and what is commonly referred to as " learning disability " is deliberately blurred.

Other self-help groups have taken up the "people first" impulse benevolently:

“'[G] eally disabled people' are often not taken seriously. You then talk to them like children. Or you don't talk to them at all. Often only their companions are addressed. People from the self-help organization 'People First' say: The term 'people with learning difficulties' is better. We think so too. "

- Berlin inklusion eV association

The term “people with learning difficulties” has also found its way into scientific studies.

Some local associations of Lebenshilfe for people with intellectual disabilities have deleted the term "intellectual" from their names due to their opening to other disabled people, while others have kept the old name. In an information brochure published by the Bundesvereinigung Lebenshilfe, it is already acknowledged that "mental disability ... maybe not a word for the future" and that it will only be used until a better term is found.

The Lebenshilfe Austria has already decided to call on the federal level now "Self-help for people with disabilities" and to completely give up the "mental". Alternatives are currently being considered; the aim is to find “a new definition and a classification based on the description of cognitive abilities”. Other self-help organizations also consider the compromise to keep the term “disability” (without attribute) acceptable, especially since it is a key term in German social law, without which one cannot make any useful statements about the legal situation.

One problem with the complete abandonment of the word field “disability” in connection with the term “people with learning difficulties” is that, according to a study, 20 to 25 percent of all children and young people in Germany are said to be affected by “learning difficulties”. Most of these young people are not considered to be disabled. In fact, psychologists refer to "rather temporary, partial and lighter forms of learning difficulties" as "learning difficulties". When the phrase “person with learning difficulties” in the sense of “person first” becomes common usage, z. For example, only those who know that training courses to become a specialist practitioner are generally not suitable for people with intellectual disabilities can immediately start with the statement: "The training to become a 'specialist practitioner service in social institutions' takes two Years and is aimed at secondary and special school students from 16 years of age with learning difficulties “mentally handicapped school leavers are not included. (Elsewhere in the quoted text, however, it is said that the training course should "give young people with learning disabilities [sic!] A real chance on the 1st job market").

Alternative terms "differently gifted" and "people with special abilities"

Increasingly, people with intellectual disabilities are being referred to by institutions as “differently gifted” or “people with special abilities”. This term is meant seriously. The artistic work of mentally handicapped people is recognized, the results of which are assigned to the collective term Art brut . There are a number of approaches to making society aware of and promoting the creative and artistic potential of the mentally handicapped. Such is the project "Are you crazy?", In which the mentally handicapped become artistically active, with the "Promotion Prize for Art and Culture Projects for the Integration of People with Disabilities 2006" from the Republic of Austria and with a prize from the Unrest private foundation of the " SozialMarie 2008 " been awarded. However, these terms have not yet established themselves in everyday use by the majority population.

However, there is a risk of a euphemism treadmill and the term “people with special abilities” being interpreted in a conventional way. Traditionally, this term is used to describe highly gifted people and people with pronounced special talents.

Country-specific situation

While a high medical and educational standard and an improved knowledge of development opportunities mean that people with intellectual disabilities can lead a good and long life in many countries, things are still very bad in some regions. In Russia, for example, parents of a disabled child are still advised to put them in a home. Inadequate human and material resources, malnutrition and little freedom of movement and almost no educational support, support and therapy mean that many developmental steps are not achieved (walking and speaking). Often the children die before they reach puberty because they receive little or no medical treatment. Schooling is only intended, if at all, for slightly disabled children and young people, and job opportunities for adult people with disabilities are only sporadic.

Children's and young people's literature

• Rachna Gilmore: A friend like Zilla . Klopp, Munich 1997, ISBN 3-7817-0660-5 .
• Karin Jaeckel: pity? No thanks! 1990, for adolescents.
• Elizabeth Laird: Ben laughs . 1999, from 14 years.
• Grete Randsborg-Jenseg: Dear nobody . 1997, from 14 years.
• Inge Obermayer: Georgie . Ueberreuter, Vienna 1989, ISBN 3-8000-2305-9 .
• Renate Welsh: Dragon wings . dtv, Munich 1992.
• Sarah Weeks: So B. It . Hanser, Munich 2005, ISBN 3-446-20643-4 .

literature

• Albert Lingg, Georg Theunissen: Mental disorders in the mentally handicapped . Freiburg im Breisgau 1993.
• Georg Feuser: There are no mentally handicapped people! Projections and artifacts in education for the mentally handicapped. In: Intellectual Disability. 1/1996, pp. 18-25.
• A. Doses: Mental disorders in the mentally handicapped. Gustav Fischer Verlag, 1997.
• Otto Speck : System of curative education. An ecologically reflective foundation. Munich / Basel 1998.
• Erhard Fischer (ed.): Education for people with intellectual disabilities. Perspectives - theories - current challenges. Oberhausen 2003.
• Ernst Wüllenweber, Georg Theunissen, Heinz Mühl (eds.): Pedagogy for mental disabilities. A manual for study and practice . Stuttgart 2006.
• Angela Moll: The sexuality of the mentally disabled - disabled sexuality? Schwäbisch Hall 2010.
• Erik Bosch: Sexuality and relationships in people with an intellectual disability. A manual and workbook. 3. Edition. dgvt, Tübingen 2013, ISBN 978-3-87159-031-3 .

Web links

• Delays in development and disability - kindergesundheit-info.de: independent information service from the Federal Center for Health Education (BZgA)
• Overview of the historical development of pedagogy for intellectual disabilities in Germany
• The website of Lebenshilfe for people with intellectual disabilities e. V.
• bidok: Digital full-text library on disabled and integration education
• Prof. Dr. Georg Feuser: Various texts for download
• Work on diagnosis (creation) "intellectual disability"
• Sexuality and Intellectual Disability - Disabled Sexuality?
• European Manifesto "Minimum Healthcare Conditions for People with Intellectual Disabilities"

Individual evidence

1. ↑ Corona: Intellectual disability does not mean an increased risk . aerzteblatt.de. June 18, 2020, accessed August 25, 2020
2. ↑ Douglas Almond, Bhashkar Mazumder: Health Capital and the Prenatal Environment: The Effect of Material Fasting During Pregnancy. (Working Paper 14428). National Bureau of Economic Research , 2009.
3. ^ Archives of Infernal Medicine. 2010, 170, p. 1135, quoted from the Ärztezeitung, July 14, 2010, p. 4.
4. ↑ Bundesvereinigung Lebenshilfe: School integration is the stepchild of German educational policy ( Memento of the original from October 21, 2007 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. . July 10, 2007.  
5. ↑ Julia Zinsmeister: Sexualassistent: Offers in the context of legal bases - answers to questions from pro familia . In: pro familia : Sexual assistance for women and men with disabilities . 2005, pp. 11-16.
6. ^ Institute for Human Rights: Convention on the Rights of Persons with Disabilities of December 13, 2006
7. ^ Klaus Dörner : Citizens and Irre. On the social history and sociology of science in psychiatry. 2nd Edition. Frankfurt am Main 1984, p. 163.
8. ↑ Peter Masuch : What did the UN-CRPD bring for better participation in working life? Speech given at the Werkstättentag in Chemnitz on September 21, 2016 . P. 7 f.
9. ↑ Guidelines for teaching in the School for Practically Formable (special school) from November 21, 1983
10. ↑ Gudrun Erlinger: Self-determination and self-representation of people with learning difficulties . 2004. http://bidok.uibk.ac.at/library/erlinger-selbstbestaltung.html#id3010089
11. ↑ [1]
12. ↑ Together we can move forward - life support on the way to the future . December 2005.
13. ↑ Lebenshilfe-Zeitung , 12/2005, p. 10.
14. ↑ berliner STARThilfe eV: "People with Disabilities" - an attempt at definition ( memento of the original from September 28, 2015 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 
15. ^ Andreas Gold: Learning difficulties. Causes, diagnosis and intervention . June 13, 2014, p. 7.
16. ↑ David Fürst / Magdalena Müller / Debora Fürst: School & Disability: Learning Disability ( Memento of the original from March 4, 2016 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. . Institute for Psychology at the Rheinisch-Westfälische Hochschule Aachen, November 10, 2006. 
17. ↑ Malteser Krankenhaus Seliger Gerhard Bonn / Rhein-Sieg: Real chance on the 1st job market. New training for young people with learning difficulties also in Bonn
18. ↑ cm.wvnet.at
19. ↑ iwanuschka.de

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !

Please note the information on legal issues!