In 1980 the World Health Organization (9) proposed a system of classification which attempted to overcome the limitations of other methods of classification and most importantly aimed to guide intervention. Table ?, and summarize the terms and illustrate how they link together. Mental retardation can be conceptualized at different levels. In the case of impairment, the organ system involved is that of the central nervous system. It is the impairment of this system for genetic, chromosomal, or environmental reasons that have primarily affected the acquisition of developmentally determined skills and the ability to learn. Certainly, early in a person's life a key task is to identify the reasons for any abnormality of brain development and therefore intellectual impairment. This may have treatment implications, may guide prognosis and, most importantly, may help to make sense of the disability for the parents of those affected. It may also have important implications for genetic counselling.
Table 2 Impairments, disabilities, and handicaps
The associated disability is the effect of the impairment on a person's ability to learn and acquire new skills that come with development. Table.,...? These in turn enable the acquisition of increasingly advanced skills necessary for an independent life. The exact nature and extent of the disability may not only include learning disabilities but also physical and sensory disabilities. The extent to which a given impairment results in a loss of function (disability) may well be influenced by the extent and nature of interventions such as special education, or the correction of hearing loss through the use of a hearing aid. The final level, that of 'handicap', is a result of an interaction between the disability and the extent to which support is available or environmental adjustments made. It is a measure of disadvantage that can be ameliorated through, for example, the presence of carers to enable individuals to go out, or environmental modifications (e.g. wheelchair ramps) that diminish the impact of physical disabilities. Such interventions or environmental modifications maximize independence and thereby reduce disadvantage by ensuring that the impact of any given disability on an individual's independence and quality of life is minimized.
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Table 3 Differences between biologically determined and subcultural mental retardation
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