Mental Retardation

MENTAL RETARDATION
Definition
• "Mental retardation refers to significantly
subaverage general intellectual functioning
resulting in or associated with concurrent
impairments in adaptive behavior and
manifested during the developmental period"
(American Association on Mental Deficiency,
1983).
Epidemiology
• About 3 percent of the world population is
estimated to be mentally retarded. In India, 5
out of 1000 children are mentally retarded
(The Indian Express, 13th March 2001).
Mental retardation is more common in boys
than girls With severe and profound mental
retardation. mortality is high due to associated
physical diseases.
Etiology
• Genetic Factors
Chromosomal abnormalities
• Down's syndrome
• Fragile X syndrome
• Trisomy X syndrome
Turner's syndrome » Cat-cry syndrome » Prader-Willi syndrome
Metabolic disorders • Phenylketonuria • Wilson's
disease•Galactosemia
Cranial malformation • Hydrocephaly • Microcephaly
Gross diseases of brain •Tuberous scleroses •Neurofibromatosis
• Epilepsy
• Prenatal Factors
• Infections • Rubella • Cytomegalovirus • Syphilis »
Toxoplasmosis, herpes simplex
• Endocrine disorders » Hypothyroidism •
Hypoparathyroidism » Diabetes mellitus
• Physical damage and disorders • Injury • Hypoxia •
Radiation • Hypertension • Anemia « Emphysema
• Intoxication • Lead • Certain drugs « Substance abuse
Placental dysfunction • Toxemia of pregnancy • Placenta
previa • Cord prolapse • Nutritional growth retardation
Perinatal Factors
• Birth asphyxia • Prolonged or difficult birth • Prematurity (due
to complications) • Kernicterus
• Instrumental delivery (resulting in head injury, intraventricular
hemorrhage)
Postnatal Factors
• Infections - Encephalitis - Measles - Meningitis - Septicemia
• Accidents • Lead poisoning
• Environmental and Socio-cultural Factors • Cultural
deprivation • Low socio-economic status • Inadequate
caretakers • Child abuse
Classification
• Intelligence quotient (IQ) is the ratio between
Mental Age (MA) and Chronological Age (CA).
While the chronological age is determined
from the date of birth, mental age is
determined by intelligence tests
• Mild Retardation (IQ 50-70) This is commonest
type of mental retardation accounting for 85-
90% of all cases. These individuals have
minimum retardation in sensory-motor areas.
• Moderate Retardation (IQ 35-50) About 10
percent of mentally retarded come under this
group.
• Severe Retardation (IQ 20-35) Severe mental
retardation is often recognized early in life
with poor motor development and absent or
markedly delayed speech and communication
skills.
• Profound mental retardation
• This group'accounts for 1-2% of all mentally
retarded. Ihe achievement of developmental
milestones is markedly delayed. They require
constant nursing care and supervision.
Associated physical disorders are common
Signs and Symptoms
• Failure to achieve developmental mile stones
• Deficiencies in cognitive functioning such as inability to
follow commands or directions
• Reduced ability to learn or to meet academic
demands
• Expressive or receptive language problems
• Psychomotor skill deficits
» Difficulty performing self-care activities
• Neurologic impairments
• Medical problems, such as seizures
• Low self-esteem, depression and labile moods
• Irritability when frustrated or upset
• Acting-out behavior
• Lack of curiosity
Diagnosis
• History collection from parents and caretakers • Physical examination •
Neurological examination • Assessing milestones development
• Investigations
- Urine and blood examination for metabolic disorders
- Culture for cytogenic and biochemical studies
- Amniocentesis in infant chromosomal disorders
- Chorionic villi sampling
- - Hearing and speech evaluation
- - EEG, especially if seizures are present
- - CT scan
- - Thyroid function tests
- - Psychological tests like Stanford Binet Intelligence Scale and Wechsler
Intelligence Scale for Children (WISC)
Prognosis
• the prognosis for children with mental

retardation has improved and institutional
care is no longer recommended. These
children are mainstreamed whenever
feasible and are taught survival skills. A
multidimensional orientation is used when
working with these children, considering
their physiological cognitive, social and
emotional development.
Treatment Modalities
• Behavior management
• Environmental supervision
• Monitoring the child's developmental needs and problems »
Programs that maximize speech, language, cognitive,
psychomotor, social, self-care, and occupational skills
Ongoing evaluation for overlapping psychiatric disorders, such as
depression, bipolar disorder, and ADHD e Family therapy to
help parents develop coping skills and deal with guilt or anger
» Early intervention programs for children younger than age 3
with mental retardation - Provide day schools to train the child
in basic skills, such as bathing and feeding - Vocational training

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MENTAL RETARDATION

• the prognosis for children with mental

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