Mental retardation or intellectual disability? Time for a change

Recently, two commentaries appeared in this journal concerning nomenclature and use of the term ‘‘intellectual disability’’ (ID) to replace the term ‘‘mental retardation’’ (MR). Moeschler and Nisbeft [2011] argue in favor of the change, citing several reasons: First, it would bring the journal in accordance with other publications and consistent with current professional usage; second, other organizations such as NICHD and the newly designated AAIDD have altered their names in accordance with the change in terminology as recommended by AAIDD and WHO; and third, it is less offensive to persons with such impairments and their families. Despite the fact that the substitution has been made in DSM-V, the gold standard setting criteria for psychiatric and behavioral disorders in childhood, adolescence, and adults, Chiurazzi [2011] argues against the switch. He cites as justifiable the following reasons for not making the change: First, the term ‘‘retardation’’ refers to the correct notion that the disability is developmental; second, ‘‘intellectual disability’’ may not only be coincident with developmental delay, but also result from brain trauma, stroke, or some neurodegenerative disorder. Therefore, ID is less precise than MR. Third, better terms are available, such as ‘‘developmental delay’’ and ‘‘developmental cognitive impairment. ’’ Finally, perhaps in the future, ‘‘disabled’’ will be as offensive as ‘‘retard,’’ as the term, disabled, is currently in Italy. In lieu of the change, Chiurazzi proposes that greater efforts be made to provide services and integrate these individuals into the mainstream community. Although I have some concerns about some of the fine points made by Moeschler and Nisbeft [2011], their argument is essentially sound. My disquiet pertains to the issues posed by Chiurazzi [2011]. Perhaps it would be best to examine each of his points one at a time. Regarding the notion that retardation correctly refers to cognitive deficits as developmental delay: of measures available for assessing infant development, possibly the best known and most frequently used is the Bayley Scales of Infant Development (BSID). The BSID was designed to discriminate typically developing infants from those with potential neurological problems. The BSID is composed of two scales, mental and motor. According to an early assessment by Berk [1979], the Motor Scale, not the Mental Scale, provided the most accurate identification of infants with neurological impairments. Some years later, Crowe et al. [1987] used the BSID to examine whether scales scores at age 2 years were related to motor and cognitive performance at age 4/2 years. These researchers found low correlations between test–retest measures and cautioned professionals about the use of the BSID to predict preschool cognitive ability. Taken together, these studies suggest that the empirical relationship between apparent developmental delay and later ID or MR is at best questionable, thus strongly implying that retardation is not the correct label for developmental delay. As for the lack of precision and conflation of ID with traumatic brain injury (TBI), cardiovascular incidents, or neurodegenerative disease, it will be useful to turn to the published literature in these areas. With regard to TBI, early references to pediatric brain injury and neurobehavioral outcome refer to the neurobehavioral sequelae as ‘‘decline in performance. , intelligence, memory, . , [and] adaptive problem solving. ’’ Jaffe et al. [1992]; or, more recently, ‘‘[a] clear relationship was documented between injury severity and cognitive performance’’ [Anderson et al., 2005]. Typical phrases found are ‘‘pediatric disability,’’ ‘‘childhood disability,’’ ‘‘cognitive impairment’’ or ‘‘poor cognitive outcome’’ [Anderson et al., 2009]. If the phrase, ‘‘intellectual disability’’ is in the TBI literature, it is not common parlance. The same can be said of neurodegenerative disorders. Cognitive impairment of this sort is most commonly referred to as one or another form of dementia, or as intellectual decline, as distinguished from intellectual disability (Cf. e.g., Janicki and Dalton, 2000). Therefore, to suggest that ID is not sufficiently specific to MR does not coincide with the current terminology in use with TBI or dementia. As for better terms, the issue regarding the use of developmental delay was addressed earlier. Aside from being a mouthful, the term ‘‘developmental cognitive impairment’’ preferred by Salvador-Carulla