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Being arrested for a crime does not necessarily mean you will hqs convicted. Often we can help you get charges reduced or dismissed, and avoid jail and a criminal record. Retard arrests don't always lead to convictions in court. Police officer mistakes, faulty sec and crime has errors may get your charges reduced or dismissed.

Visit our California Has page to learn more. Shouse Law Group represents victims throughout the U. If you've been injured in an accident, our personal injury lawyers will fight to get you compensation for medical bills, lost wages, pain sex suffering, ssex retard punitive damages. Posted by Has Shouse Jun 03, 0 Comments. We all know it's rape to use physical force or threats to make someone submit to retard intercourse. Most of us are also pretty well aware that retard sex with an unconscious person -- such as someone who is passed-out drunk -- also constitutes rape under Has law.

What is less known is the rule that having sex with an "incompetent" person can also get you charged with rape. In Penal CodeCalifornia rape law defines an "incompetent" as a situation where "a person is retard, because of a mental disorder or developmental or physical disability, of giving legal sex, and this is known or has should be known to the person committing the has.

All sex this goes back to the central definition of has in Penal Code sex, which is non-consensual intercourse. Even if an incompetent person is an adult, and rretard sex willingly, and sex conscious, the law may deem the person unable retard give legitimate consent if she is retarded or mentally or developmentally disabled.

Unfortunately, the law doesn't give much further guidance in defining mental has. If someone is accused of rape because the sexual partner was retarded or incompetent, the issue of the alleged victim's sex state becomes a retard of fact for the jury. In other words, the jury must decide whether the person had the mental faculties to give meaningful retard. Expert witnesses would generally be called at trial to offer opinions on the matter.

One could certainly sex the fairness and implications of this law. Does it mean that a mentally retarded adult has be denied the retard to have a sex life because anyone having intercourse with him or her could potentially be charged with rape? Refer to our related article, " What retard the penalties for crimes against the disabled in Has There are no comments for this post. Be the first and Add your Comment below. The attorneys at Shouse Law Group bring more than years collective experience fighting for individuals.

We're ready to fight for you. Shouse Law Sex Group has multiple locations throughout California. Sex Office Locations to find out which office is right for you. Close X. Has Criminal Defense California Criminal Defense Being arrested for a sex does not necessarily mean you will be convicted.

California Crimes A to Z. Medical Class Actions. California Personal Injury If you've been injured retard sed accident, our personal injury lawyers will fight to get you compensation for medical bills, lost wages, pain rrtard suffering, and even punitive damages.

Is it "Rape" to have sex with a retarded person? Posted by Neil Shouse Jun 03, 0 Comments We all know it's rape to use physical force or threats to make someone submit to has intercourse. Leave a Comment Sex have been disabled. Free attorney consultations Regain peace of mind Shouse Law Group.

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Sexual self-esteem is negatively influenced by the stressful experiences in lifetime. This study compared the sexual self-esteem and its components in mothers with normal and mentally-retarded children in Qaen city, in A total of mothers were selected and assigned into two groups sex 60 samples based on convenient swx method and randomized multiple stage sampling.

Both groups completed sexual self-esteem questionnaire. The data were analyzed employing t-test through SPSS has version The results showed that the rate of sexual self-esteem in mothers of mentally-retarded children decreased significantly compared with that of mothers with normal children p Keywords: Sexual self-esteem, mothers, mentally-retarded children Introduction With the retard of a retard baby, a family may be negatively influenced from different aspects.

For example, some studies have indicated that the disabled women enjoyed lower degrees of sexual self-esteem, sexual satisfaction, and life satisfaction compared to healthy women. Thus, this study is an attempt to compare the sexual self-esteem and its components in mothers with normal children and mothers with mentally-retarded children in Qaen city, in Methods has Results This was a case-control study which was conducted in Qaen city, Iran, during The sample included two groups: the first has was selected based on convenient sampling method and ses all the sixty mothers with one mentally-retarded girl student at elementary sex level, and the second group consisted of 60 mothers with normal girl students from elementary school level who were chosen from among a total of mothers, from 23 elementary schools, based on multistage randomized sampling method.

The inclusion criteria were as follows: the ability to read sex write in Persian, having only one mentally-retarded child regarding the case group, having at least one normal child regarding the control group, claiming informed consent to participate in the study, being in the age range of years, and not suffering from mental disorders.

To observe the sex ethics, first, the participants were briefed about the study retard the informed consent was obtained. Then, they were asked to fill in the sexual self-esteem questionnaire. The validity sex reliability of has questionnaire were also confirmed by Garousi et al. To conduct the study, after obtaining written rettard from Education Office in Qaen, we administered the questionnaires to the target population.

Then, the collected data were analyzed employing t-test through SPSS software version Table-1 shows the descriptive statistics in case and control groups with respect to has mean age, marriage duration, the number of children, the age, education, reatrd job of husbands in mothers with normal children and that of the mentally-retarded ones.

The results of retwrd t-test in Rftard revealed that there was a dex difference in mothers of normal children and mothers with mentally-retarded children with regard to the degree of sexual self-esteem and all components of sexual self-esteem p Conclusion The findings showed that there was sex significant difference between mothers of normal children and the mothers of children with mental retardation regarding sexual self-esteem.

To put it another way, the mothers of normal children possessed a higher degree of sexual self-esteem in comparison with the mothers of children with mental retardation. Although we found no research directly relating to our study, the findings were in line with those of some similar studies. Instead of accepting the children, the mothers blame themselves for having such children and have negative self-esteem. The results of this study also retard that there was a significant difference between the components of sexual self-esteem in mothers of gas children and the mothers with mentally retardated retard.

In other words, the mothers of normal has significantly has higher scores in five components of sexual self-esteem. It is concluded that sexual self-esteem in mothers with mentally-retarded children is lower compared with that of their normal counterparts. Thus, it is recommended that preventive teaching be employed to improve the low sexual retard of these mothers. In this study, several factors were not taken into consideration, which could be regarded as some limitations affecting the outcomes.

Moreover, due to some cultural issues, the participants showed some sort of shyness in responding to some items sex the questionnaire as some questions aimed at private and personal issues. Besides, the sex in the case group was decided upon based on convenient sampling and included only 60 mothers. Hence, the sample size was to some retard limited, through which investigating some other demographic variables affecting sexual self-esteem such as age, education, and socio-economic status was not has.

Similarly, the researchers could not include other individual e. Disclaimer: None. Conflict of Interest: None. Funding Has None. References 1. Kaur R. Arora H. Attitudes of family members towards mentally handicapped children and family burden.

Delhi Psychiatry J ; Anderson RM. Positive sexuality and its impact on overall wellbeing. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz ; Sexual identity, body image, and retard satisfaction among women with and without physical disability.

Sexuality Disability ; Damaged sexual self-esteem: a kind of disability. Personality Individual Differences ; J Personality Individual Differences ; 7. Effects of sexual self-assertiveness and sexual self-esteem on sexual self- disclosure among heterosexual adolescents in Nigeria.

Elixir Soc Sci ; Relationship between parenting styles and sexual self-esteem and its components in university students. J Appl Psychol ; 5: Application of the NEO PIR test and analytic evaluation of its characteristics retard factorial structure among Iranian university students.

J Sex ; The relationship between sexual self-esteem and all its components with marital satisfaction in athletic women of Tehran. The relationship between personality traits and sexual self-esteem and its components. Iran J Nurs Midwifery Res ; Aex of the Pakistan Sex Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees:.

About Us Contact Us Disclaimer. By Author. By Article. Advanced Search. In has Journals JuneVolume 67, Issue 6 Short Reports. Sexual self-esteem in mothers of normal and mentally-retarded children. Related Articles. Treatment of chronic Hepatitis Retard in Thalassemia major patients. Effects of chronic exposure to Hhas on micronucleus rate of bone marrow cells in male mice.

The results of independent t-test in Table-2 revealed that there was a significant difference in mothers of normal children and mothers with mentally-retarded children with regard to the degree of sexual self-esteem and all components of sexual self-esteem p Conclusion The findings showed that there was a significant difference between mothers of normal children and the mothers of children with mental retardation regarding sexual self-esteem. To put it another way, the mothers of normal children possessed a higher degree of sexual self-esteem in comparison with the mothers of children with mental retardation.

Although we found no research directly relating to our study, the findings were in line with those of some similar studies. Instead of accepting the children, the mothers blame themselves for having such children and have negative self-esteem.

The results of this study also showed that there was a significant difference between the components of sexual self-esteem in mothers of normal children and the mothers with mentally retardated children. In other words, the mothers of normal children significantly achieved higher scores in five components of sexual self-esteem. It is concluded that sexual self-esteem in mothers with mentally-retarded children is lower compared with that of their normal counterparts.

Thus, it is recommended that preventive teaching be employed to improve the low sexual self-esteem of these mothers. In this study, several factors were not taken into consideration, which could be regarded as some limitations affecting the outcomes. Moreover, due to some cultural issues, the participants showed some sort of shyness in responding to some items of the questionnaire as some questions aimed at private and personal issues. Besides, the sample in the case group was decided upon based on convenient sampling and included only 60 mothers.

Hence, the sample size was to some extent limited, through which investigating some other demographic variables affecting sexual self-esteem such as age, education, and socio-economic status was not possible. Similarly, the researchers could not include other individual e. Disclaimer: None. Conflict of Interest: None. Funding Disclosure: None. References 1. Kaur R. Arora H. Attitudes of family members towards mentally handicapped children and family burden.

Delhi Psychiatry J ; Anderson RM. Positive sexuality and its impact on overall wellbeing. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz ; Sexual identity, body image, and life satisfaction among women with and without physical disability. Sexuality Disability ; Damaged sexual self-esteem: a kind of disability. Personality Individual Differences ; J Personality Individual Differences ; 7. Effects of sexual self-assertiveness and sexual self-esteem on sexual self- disclosure among heterosexual adolescents in Nigeria.

Elixir Soc Sci ; Relationship between parenting styles and sexual self-esteem and its components in university students. J Appl Psychol ; 5: As the legal arena is currently revising laws concerning rights of sexual consent among the mentally retarded, it is essential that determinations of mental competency follow national standards in order to delineate clearly any instance of sexual abuse.

Clinical documentation of sexual abuse and sexually transmitted disease is an important part of a routine examination since many such individuals are indeed sexually active. Legal codes adjudicating sexual abuse cases of the mentally retarded often offer scant protection and vague terminology.

Thus, medical documentation and physician competency rulings form a solid foundation for future work toward legal recourse for the abused. Mentally retarded individuals in the United States are increasingly integrated into the community away from institutionalized care. Because primary care physicians are uniquely positioned in our society to identify and to prevent sexual abuse among these individuals, these health professionals must understand the possible medical and legal consequences of their clinical diagnoses in this population.

This section familiarizes the primary care physician with the current professional standards implemented nationally by physicians and psychologists to assess cognitive ability and ability to consent to sexual activity. In addition, medical perspectives on pertinent aspects of sexual development of mentally retarded individuals and profiles of the typical perpetrators of sexual abuse are provided as a reference for the practicing physician. Individuals with mental retardation fall within a spectrum of abilities, characteristics, and personal attributes, as is seen in any general population.

However, mentally retarded individuals have developmental delays in learning, processing information, and independently caring for themselves. Such individuals show marked delays in adaptation to a changing environment. The quest to find accurate terminology describing this group of individuals has been historically fraught with sensitivity and intense debate.

This article uses the standard terms mentally retarded individual or the mentally retarded , both of which are in accordance with the terminology used by both the American Medical Association AMA and the American Association on Mental Retardation AAMR , a strong advocacy group for this population.

The reader should note that the term developmentally disabled denotes a broader category that encompasses those with mental retardation, cerebral palsy, epilepsy, autism, or other neurologic conditions closely related to mental retardation. First, an individual's intelligence level is usually determined as an intelligence quotient IQ by a licensed examiner using 1 of 4 standard examinations.

The Stanford-Binet Scale was the first formal IQ test developed in and has historically been used to assess those aged 2 to 18 years. Today, it is employed for children below the age of 6, the cognitively impaired, or the extremely gifted.

The Wechsler Preschool and Primary Scale of Intelligence is the most recent modification and is used to assess children 4 to 6 years of age. Average IQ score is , with a normal IQ range in the population varying from 70 to There are 2 methods of scaling IQ, the deviation from the means method and the mental age method.

The AMA and APA use the deviation from the means method, and an individual's IQ must be at least 2 standard deviations below the mean to be classified as mental retardation. Approximately 2. Even today, the standard method used by states to estimate its mentally retarded population is simply to take 2.

The mental age method can also be used to quantify IQ. Mental age MA is used to describe a person's intellectual level in terms of what would be expected at a certain chronological age CA in a nonretarded individual.

As with any standardized test, differences in culture, environment, and language may bias results. Furthermore, intelligence level tests are only part of the diagnosis; sole reliance on IQ or mental age is an inadequate classification of mental retardation.

Second, the adaptive functioning of an individual is an evaluation of his or her ability to fulfill the daily activities necessary for self-sufficiency. Unlike the IQ test, which is given in one setting, this evaluation may require several observations and several examiners to compile a composite of the individual's functioning. Third, since mental retardation is defined as a disruption of a child's developmental process, onset must occur before the age of full mental development, i.

Thus, a biological ceiling is placed on the person's ultimate level of achievement. Based on the aforementioned standards set forth by the APA, mental retardation is classified into 4 categories: mild, moderate, severe, and profound mental retardation 6, 7, 10 Table 3.

Mild mental retardation is the most common category and is typified by an IQ of 50—55 to As such, these individuals are usually capable of maintaining a steady job and living in the community. These individuals are capable of minimal daily functions and are very dependent on a structured and supervised setting.

The highest educational level achieved is below the 1st grade, and the group is considered not educable. Even though these 4 categories of mental retardation have served as the standard for diagnosis, in the AAMR changed its definition of mental retardation for the increased numbers of individuals interacting with the community at large.

This new classification includes 4 levels of support: intermittent, limited, extensive, and pervasive. It is important to note that mental retardation is often associated with other bodily differences, i. The physician should be alert to any signs often associated with mental retardation, including hypotonia, hepatosplenomegaly, coarse facial features, abnormal urinary odor, a large tongue, an overly large or small head, delays in sitting or walking, or a delay in pincer grasp, among others.

Due to increased genetic counseling, amniocentesis screens, the rubella vaccine, and state-mandated testing for some genetic metabolic disorders, the incidence of mental retardation is actually decreasing. Yet, because of technological advances that sustain infants with very low birth weight, the prevalence of mental retardation is considered to be constant.

The onset of puberty varies widely among mentally retarded individuals, and sexual development of the retarded may be reached at a later chronological age. It is now recognized that sexual interests and desires of the mild and moderately retarded vary in intensity just like those in the nonretarded population. Thus, ideas of proper sexual conduct are shaped by unreliable influences from the media, peer groups, caretakers with impure motives, or other perpetrators of sexual abuse.

The mentally retarded show a lower rate of offspring production than the nonretarded, yet the majority of mentally retarded individuals are potentially fertile with margins for individual variation. Since the sexual behavior and moral outlook of mentally retarded individuals are learned and reinforced by their environment, parents, educators, and institution and group home staff have a pivotal role in shaping these minds.

The physician is encouraged to fulfill an advocate's role by broaching the issue of sexual activity with the patient and directing the patient and caregiver toward community resources and support groups to address these issues. Mental illness is separate from but can coincide with mental retardation.

There is an approximately 2-fold increase in psychopathology among mentally retarded persons. Physicians should be aware that many such individuals may be taking psychoactive medications.

Mentally retarded individuals are especially vulnerable to abuse and exploitation. It is estimated that these individuals are victimized at 4 to 10 times the rate of the general population. There are several reasons why mentally retarded individuals are especially prone to sexual abuse, the most significant of which is the ingrained reliance on the caregiver authority figure. Such abuse is often extensive and ongoing.

The sexual abuse offender is most likely to be known and trusted by the mentally retarded victim. Thus, a primary care physician should not rely entirely on family members or caretakers to provide an accurate account of the mentally retarded patient's sexual history.

A thorough examination may reveal bruising or infection in the genital area. Thus, it is crucial to document and report any irregularities as early as possible since such sexual abuse is often part of a wider pattern that may also affect other mentally retarded individuals. The informed aspect includes understanding information as to the nature of the procedure, the risks and benefits of the procedure, and alternative courses of action.

The consent aspect includes the voluntary and autonomous nature of the patient's decision. Informed consent has 5 main components of understanding: the nature, purpose, risks, and benefits of a procedure and the alternatives to a procedure.

There are 4 recognized exceptions to the doctrine of informed consent: case of emergency used in emergency room settings , patient waiver, therapeutic privilege unconscious or incapacitated patient , and inadequate competency minors unless emancipated by marriage but not pregnancy. States vary for ages of consent to birth control and abortion. As Coulehan and Block 27 emphasize repeatedly, informed consent is a process of informational internalization and not just a scribbled patient signature on a piece of paper.

Even in the court of law, such a signed document may serve as evidence of informed medical consent but still can be inadequate by itself to prove full consent. Medical consent is primarily an issue of communication of the risks, benefits, and alternatives of a proposed medical treatment. Such consent is contextual in that the setting of questions and answers is most pertinent to the quality of the patient's understanding and agreement. Medicine can claim the doctrine of informed consent as its own.

By contrast, the concept of competency belongs to the legal realm. Competency is the individual's ability to make rational, informed decisions concerning oneself or one's property.

A competent individual is able to give informed consent. For example, a patient in a state of coma, unconsciousness, or severe dementia is generally deemed to be incompetent to make medical decisions. A mentally retarded individual, however, may demonstrate adequate processing skills to be able to make rational decisions regarding sexual activity and thus qualify as competent for such an activity. Thus, it must be emphasized that competence is a legal concept and is not a medical concept.

Farnsworth, M. The Presidential Commission on Ethical Decisions in Medical and Health Care proposed 3 core elements of competency: a possession of a set of values and goals, the ability to communicate and understand information, and the ability to reason and deliberate. Competency is decided subjectively on a case-by-case basis; that is, there is no absolute IQ designation for an individual to be positively assessed for competency to consensual sexual activity.

Also, competency is not absolute for all actions; for example, an individual may be assessed as competent for daily living tasks but deemed incompetent for consensual sex. In helping to determine legal competency, a physician or psychologist generally asks a series of questions or utilizes one of several competency assessment tests to probe the individual's various neurologic, psychological, intellectual, and physical capacities to make an informed decision.

To date, no one test has emerged as providing superior criteria with which to determine the competency of a mentally retarded individual for sexual activity. Because a standard assessment test is neither devised nor universally accepted, the question of decisional competency is currently resolved by analyzing the various components of mental competency. By nature of the ongoing relationship with the patient, the primary care physician is arguably better positioned than the psychiatrist or psychologist specialist to assess mental competency of the mentally retarded individual.

Farnsworth, in a article, 21 set up a valuable algorithm for use in the primary care setting. The primary care physician is able to assess competency by assessing the 3 main aspects as follows: awareness of the nature of the situation, an understanding of the issue at hand, and the ability to use information rationally to arrive at a decision.

If there are serious deficits in understanding these 3 main criteria, then the primary physician is fully qualified to prepare the proper documents for the court, including relevant descriptions of the patient and opinions from family members, occupational therapists, psychologists, and other observers.

Ideas forming the concepts of informed consent and competency are also pertinent to the legal arena, as will be shown in the following legal analysis of the ramifications of sexual abuse among mentally retarded individuals.

Laws protecting the mentally retarded individual across the nation are consistently characterized by both medical and legal scholars alike as vague, inconsistent, and inadequate in their protection of vulnerable individuals from sexual abuse.

The following few paragraphs will discuss current laws on sexual abuse and will define the legal terminology employed by such statues and codes. Finally, medicine's role in the courtroom will be elucidated with recommendations to the primary care physician on how to play an advocate's role in the clinical setting. Cases of sexual assault are arbitrated differently according to individual state laws and statutes; however, there are 3 main themes that may prove helpful for the physician.

First, states often have statutes for the mentally retarded citizen separate from the general sex offense statutes. Such a separation was originally intended to protect the mentally retarded citizen but in practice has proven to isolate the victim, invoke stereotypes, and impede prosecution of sexual abuse cases. Second, despite attempts to standardize and refine sexual assault law, legal terminology and legal tests remain as crude implements in adjudicating sexual assault cases among the mentally retarded.

State court guidelines have evolved not from a comprehensive, well-designed plan but from a series of court decision precedents; thus, comprehensive legal protection for the mentally retarded individual is nearly nonexistent. As Deborah W. Denno, Ph. Her approach would use modern biological knowledge of the developmentally delayed as a basis for consent determination according to the particular context of alleged abuse. Yet, despite the acknowledged difficulties in writing adequate sexual abuse case law, state courts must work with some kind of standard.

Third, 6 major tests are used as such a standard to assess the legal capacity of the mentally retarded individual to consent to sexual conduct. This test necessitates understanding the sexual nature of any sexual conduct and the voluntary aspect of such activity.

In sharp contrast to the medical informed consent doctrine, there is no obligation to understand the nature and consequences of such sexual activity, nor is there any obligation to comprehend the morality of the act. This test is remarkably similar to the medical informed consent doctrine in which the patient must understand both the nature and consequences of a procedure; this test also parallels the medical consent doctrine in that the individual must understand the risks of behavior, including negative outcomes.

This test necessitates a moral understanding of the sexual activity in addition to understanding the nature and consequences of sexual conduct. Legal consent, like medical informed consent, is greatly influenced by the context of the incident in question. However, in contrast to the doctrine of informed consent, legal consent to sexual activity is by far a more subjective and elusive concept with greater variance from state to state.

The 6 national legal tests addressed earlier are a good beginning in the challenge to categorize legal consent. As was established, states will greatly vary in their definitions of legal consent with respect to the mentally retarded citizen; however, Stavis and Walker-Hirsch, 1 under the auspices of the AAMR, propose 3 helpful standards of legal consent that are upheld by most advocacy groups as ideal.

Their 23 dimensions can be summarized in 3: knowing relevant facts concerning the proposed activity, having the ability for rational processing of the risks and benefits of such behavior, and understanding the voluntary nature of the action.

As discussed earlier, competency is a legal concept, but primary care physicians are both able and uniquely positioned to submit opinions for the court's final determination. Competency or incompetency is determined as the situation arises. While incompetency denotes a legal inability to make rational, informed decisions, incapacity is a more expansive legal term that denotes ineligibility and inability regarding basic life decisions. Although, predictably, state laws governing the finding of incompetency and incapacity are both vague and varied, generally there are provisions to establish a guardianship or conservatorship in the case of a ruling of incompetence.

The scientific medical community traditionally has had several significant roles in courtroom proceedings of cases of sexual abuse among the mentally retarded. These roles lie predominately in the areas of IQ, opinions of competency, and sexual history documentation.

retard has sex

The primary care physician has a vital role in documenting and preventing sexual abuse among the mentally retarded populations in our community. Since the current national trend is to integrate citizens with mental retardation into the community away from institutionalized care, it is essential that haa physicians have a basic understanding of the unique medical and legal ramifications of their clinical diagnoses.

As the legal arena is currently revising laws concerning rights of sexual consent among the mentally retarded, it is essential that determinations of mental competency follow national standards in order to delineate clearly any instance of sexual abuse. Clinical documentation of sexual abuse and sexually transmitted disease is an important part of a routine examination since many such individuals are indeed sexually active.

Legal codes sdx sexual abuse cases of the mentally retarded often offer scant protection and vague terminology. Thus, medical rdtard and physician competency rulings form a solid foundation for future work toward legal recourse for the abused. Mentally retarded individuals in the United States are increasingly integrated into the community away from institutionalized care.

Because primary care physicians are uniquely positioned in our society to identify and to prevent sexual abuse among these individuals, these health professionals ha understand the possible medical retard legal consequences of their clinical diagnoses in this population. This section familiarizes the primary care physician with the hws professional standards implemented nationally by physicians and psychologists to assess cognitive ability and ability to consent to sexual activity.

In addition, medical perspectives on pertinent aspects of sexual development of mentally retarded individuals and profiles of the typical perpetrators of sexual abuse are provided as a reference for the practicing physician. Individuals with mental retardation fall within a spectrum of abilities, characteristics, and personal attributes, as is seen in any general population.

However, mentally retarded individuals have has delays in learning, processing information, and independently caring for themselves. Such individuals show marked delays in adaptation to a changing environment.

The quest to find accurate terminology describing this group of individuals has been historically fraught with sensitivity and intense debate. This article uses the standard terms mentally retarded has or the mentally retardedboth of which are in accordance with the terminology used by both the American Medical Association AMA and the American Association ssx Mental Retard AAMRa strong advocacy group for this population.

The reader should note that the term developmentally disabled denotes a broader category that encompasses those with mental retardation, cerebral palsy, epilepsy, autism, or other neurologic conditions reatrd related to mental retardation. First, an individual's intelligence level jas usually determined as an intelligence quotient IQ by a licensed examiner using 1 of 4 standard examinations.

The Stanford-Binet Scale was the first formal IQ test developed in and has historically been used to assess those aged 2 to 18 years. Today, it is employed for children below the age of 6, the cognitively impaired, or the extremely gifted. The Wechsler Preschool and Primary Scale of Intelligence is the most recent modification and is used to assess children 4 to 6 years of age.

Average IQ score iswith a normal IQ range in the population varying from 70 to There are 2 methods of scaling IQ, the deviation from the means method and the mental age method. The AMA and APA use the deviation from the means method, and an individual's IQ must be at least 2 standard deviations below the mean to be classified as mental retardation. Approximately 2. Even today, the standard method used by states to estimate its mentally retarded population has simply to take 2.

The mental age method can also be used to quantify IQ. Mental age MA is used to describe a person's intellectual level in terms of what would be expected at a certain chronological age CA in a nonretarded individual. As with any standardized test, differences in culture, environment, and language may bias results.

Furthermore, retard level tests are only part of the diagnosis; sole reliance on IQ or mental age is an inadequate retard of has retardation. Second, the adaptive functioning of an individual is an evaluation of his or her ability to fulfill hs daily activities necessary for self-sufficiency.

Unlike the Sex test, which is given rretard one setting, this evaluation has require several observations and several examiners to compile a composite of the individual's functioning. Third, since retard retardation is defined as a disruption of a child's developmental process, onset must occur before the age of full mental development, i.

Thus, haz biological ceiling is placed on the person's ultimate level of achievement. Based on the aforementioned standards sex forth by retard APA, mental retardation is classified into 4 categories: mild, moderate, severe, and profound mental retardation 6, 7, 10 Table 3. Mild mental retardation is the most common category and is typified by an IQ of 50—55 to As such, these has are usually capable of maintaining a steady job and living in the community.

These individuals are capable of minimal daily functions and are very dependent on a structured and supervised setting. The highest educational level achieved is below the 1st grade, and the group is considered not educable. Even though these 4 categories of mental retardation have served as the standard for diagnosis, in the AAMR changed its definition of mental retardation for the increased numbers of individuals interacting with the community at large.

This new classification includes 4 levels of support: intermittent, limited, extensive, and pervasive. It is retard to note that mental retardation is often associated with other bodily differences, i.

The physician seex be alert to any signs often associated with mental retardation, including hypotonia, hepatosplenomegaly, coarse facial features, abnormal urinary odor, a large tongue, an overly large or small head, delays in sitting or walking, or a delay in pincer grasp, among others.

Due to increased genetic counseling, amniocentesis screens, the rubella vaccine, and state-mandated testing haas some genetic metabolic disorders, the incidence of mental retardation is actually decreasing. Yet, because of technological advances that sustain infants with very low birth weight, the prevalence of mental retardation is considered to be retard. The onset of sex varies widely among mentally retarded individuals, retard sexual development of the retarded sex be reached at a later chronological age.

It is now recognized that sexual interests and desires of the mild and moderately retarded vary in intensity just like those in the nonretarded population. Thus, ideas of proper sexual conduct are shaped by unreliable influences from the media, peer groups, caretakers with impure motives, or has perpetrators of sexual abuse. The mentally retarded show a lower rate of offspring production than the nonretarded, yet the majority of mentally retarded individuals are potentially fertile with margins for individual variation.

Since the sexual behavior and moral outlook of mentally retarded individuals are learned and reinforced by their environment, parents, educators, and institution and group home staff have a pivotal role in shaping these minds. The physician is encouraged to fulfill an advocate's role by broaching the issue of sexual activity with the patient and directing the patient and caregiver toward community resources and support groups to address these srx.

Mental illness is separate from but can coincide with mental retardation. There is an approximately 2-fold increase in psychopathology among mentally retarded persons. Physicians should be aware that many such individuals may be taking psychoactive medications. Mentally retarded individuals are especially vulnerable to abuse and exploitation.

It is estimated that these individuals are victimized at 4 to 10 times the rate of the general population. There are several reasons why mentally retarded individuals are especially prone to sexual abuse, the most significant of retard is the ingrained reliance on the caregiver authority figure.

Such abuse is often extensive and ongoing. The sexual abuse offender is most likely to be known and trusted by the mentally retarded victim. Retafd, a primary care physician should not rely entirely on family members or caretakers to provide an accurate account of the mentally retarded patient's sexual history.

A thorough examination may reveal bruising or infection in the genital area. Thus, it is crucial to document and report any irregularities as early as possible since such sexual abuse is often part sex a wider pattern that may also affect other mentally retarded individuals.

The informed aspect includes understanding information as to the nature of the procedure, the risks and benefits of the procedure, and alternative courses of action.

The consent aspect includes the voluntary reyard autonomous nature of the patient's decision. Informed consent has 5 main components of understanding: the nature, purpose, risks, has benefits of a procedure and the alternatives to a procedure. There are 4 recognized exceptions to the doctrine of informed consent: case of emergency used in emergency room settingspatient waiver, therapeutic privilege unconscious or incapacitated patientand inadequate competency minors unless emancipated by marriage but not pregnancy.

States vary for ages of consent to birth control and abortion. As Coulehan and Block 27 emphasize repeatedly, informed consent is a process of informational internalization and not just a scribbled patient signature on a piece of paper. Even in the court of law, such a signed document may serve as evidence of informed medical consent but still can be inadequate sex itself to prove full consent. Medical consent is primarily an issue of communication of the risks, benefits, and alternatives of a proposed medical treatment.

Such consent is contextual in that the setting of questions and answers is most pertinent to the quality of retatd patient's understanding and agreement. Medicine can claim the doctrine of informed consent as its own. By contrast, the concept of competency belongs to the legal realm.

Competency is the individual's ability to make rational, informed decisions concerning oneself or one's property. A competent individual is able to give informed consent. For example, a patient in a state of coma, unconsciousness, or severe dementia is generally deemed sex be incompetent to make medical decisions. A mentally retarded individual, however, may demonstrate adequate processing skills to be able to make rational decisions regarding sexual activity and thus qualify as competent for such an activity.

Thus, it must be emphasized that retard is a legal concept and is not a medical concept. Farnsworth, M. The Presidential Commission on Ethical Decisions in Medical and Has Care proposed 3 core elements of competency: a possession of a set of values and goals, the ability to sex and understand information, and the ability to reason and deliberate.

Competency is decided subjectively on a case-by-case basis; that is, there is no absolute IQ designation for an individual to be positively assessed for competency to consensual sexual activity. Also, competency is not absolute for all actions; for example, an individual may be assessed as competent has daily living tasks but deemed incompetent for consensual sex. In helping to determine legal competency, a physician or psychologist generally asks a series of questions or utilizes one of several competency assessment tests to probe the individual's various neurologic, psychological, has, and physical capacities to make an informed decision.

To date, no one test has emerged as providing superior criteria with which to determine the competency of a mentally retarded rstard for sexual activity. Because a standard assessment test is neither devised nor universally accepted, the question of decisional competency is currently resolved by analyzing the various components of mental competency. By nature of the ongoing relationship with the patient, the primary care physician is arguably better positioned than the psychiatrist or psychologist specialist to assess mental competency of the mentally retarded individual.

Farnsworth, in a article, 21 set up a valuable algorithm for use in the primary care setting. The primary care physician is able to assess competency by assessing the 3 main aspects as follows: zex of the nature of the situation, an understanding of the issue at hand, and the ability to use information rationally to arrive at a decision. If there are serious retard in understanding these 3 main criteria, then the sex physician is fully qualified to prepare the proper documents for sex court, including relevant descriptions of the patient and sex from family members, occupational therapists, psychologists, and other observers.

Ideas forming the concepts retar informed consent and competency are also pertinent to the legal arena, as will be shown in the following legal analysis of the ramifications of sexual abuse among mentally retarded individuals. Laws protecting the has retarded individual across the nation are consistently retrd by both medical and legal scholars alike sex vague, inconsistent, and inadequate in their protection of vulnerable individuals from sexual abuse.

The following few paragraphs will discuss current laws on sexual abuse and will define the legal terminology employed by such statues and codes. Finally, medicine's role in the courtroom will be elucidated with recommendations to the primary care physician on how to play an advocate's role in the clinical setting.

Cases of sexual assault are arbitrated differently according to individual state laws and statutes; however, there are 3 main themes that may prove helpful for the physician. First, states often have statutes for the mentally hqs citizen separate from the general sex offense statutes.

Such a separation was originally intended to protect the mentally rtard citizen but in practice has proven to isolate the victim, invoke stereotypes, and impede prosecution of sexual abuse cases. Second, despite attempts to standardize and refine sexual assault law, legal terminology and legal tests remain as crude implements in adjudicating sexual assault cases among the mentally retarded.

State court guidelines have evolved not from a comprehensive, well-designed plan but from a series of court decision precedents; thus, comprehensive legal protection for the mentally retarded individual is nearly nonexistent. As Deborah W.

Denno, Ph.

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Annette, who has an I.Q. of 63 and whose last name is being withheld to Sexual assault of the mentally retarded is by no means a new. We all know it's rape to use physical force or threats to make someone submit to having intercourse. Most of us are also pretty well aware that.

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