MANAGEMENT OF CHILDHOOD

AND ADOLESCENT DISORDERS

INCLUDING MENTAL
DEFICIENCY
INTRODUCTION & DEFINITION

A child goes through many changes of various developmental stages.

These various stages cause changes in physical, cognitive, social
emotional changes. The maladaptive behaviour may be cause of
great distress and tension to the family and child himself. The child
psychiatric uses a wide range of treatment including milieu therapy,
behaviour modification, cognitive and family therapy.
• Mental retardation :- The incidence of mental retardation is estimated to
be about 2-3%. It is not a disease rather it is the result of a pathological
process in the brain characterized by limitations in intellectual and
adaptive function.
• DEFINITION: - Mental retardation refers to significantly sub average
intellectual functioning resulting in or associated with concurrent
impairments in adaptive behaviour and manifested during the
developmental period.
• Intelligence quotient (IQ) = Mental age x 100
Chronological age
Epidemiology:-
About 3% of the world population is estimated to be mentally retarded. In India, mental
retardation is more common in boys than girls.
Aetiology :
A. Genetic factors
• Down’s syndrome
• Trisomy X syndrome
• Turner syndrome
B. Prenatal factors :
• Infections
• Intoxication
• Endocrine disorders
• Environmental Factors
• Physical damage and disorder
Classification:-

1. Mild (Educable) 50 – 70 IQ
2. Moderate (Trainable) 35 – 50 IQ
3. Severe ( Dependent ) 20 – 35 IQ
4. Profound (life support) < 20 IQ
CLASSIFICATION OF MR
According to intelligence Quotient , Mental retardation is of four
types.
A. Mild mental Retardation:- This is the commonest kind of mental
retardation , accounting for 85%- 90% of cases.
 Children with IQ, 50- 70 fall in this category.
 These individuals have minimum retardation in sensory motor areas.
 They can develop social and communication skills but have deficits in
cognitive function .
 With special education , these children can progress up to 6th grade in
school.
B. Moderate mental Retardation
• About 10% of mentally retarded have moderate mental retardation. Their IQ is
between 35-50
• Communication skills develop much slowly in these individuals.
• They can be trained to support themselves by performing semiskilled under
supervision.
• So this group is referred to as “TRAINABLE MR” . During adulthood , these
people can work in supervised occupational settings.
C. Sever mental Retardation
• About 4% mentally retarded children fall in category. IQ is between 20- 35.
• These children can be given elementary training in personal health care and they
can be taught to talk. At the best they can perform simple tasks under CLOSE
SUPERVISION. This group was earlier called “Dependent”
D. Profound retardation:-

This group accounts for 1 to 2 percent of all mentally retarded . They

require constant nursing care and supervision or life support . Associated
physical disorders are common. Their IQ is below 20.
Problem / disorders associated with MR :-
1. Physical Defects:-
-Sensory disorder like Defect in Vision , Defect in hearing etc.
-Motor defects like
Ataxia ( lack of Coordination in doing voluntary activities)
Athetosis( slow, purposeless movements of hand, face etc.
2. Psychiatric disorders:-

• Schizophrenia
• Neurosis
• Mood disorders
• Personality disorders
• Autism and overactivity syndrome
• Behaviour disorder like Mannerism
DIAGNOSIS:-
The Diagnosis of mental retardation is based on the following:-
1. Thorough physical examination and history.
2. Routine developmental assessment.
3. Standardized test of intellectual and adaptive functioning .
 Management:- Prevention can be done at three levels:-
1. Primary prevention:- it consists of planned actions taken to reduce the mental
retardation . It involves strategies of health promotion and specific protection .
A. Health promotion:- it includes
• Good antenatal care
• Improving socio economic status of country
• Educating people aiming at removal of misconceptions about mentally retarded
individual.
B. Specific protection:-
It includes:-
• Good prenatal , intranatal and post natal care.
• Genetic counselling of high risk mother.
• Avoiding marriages of mentally retarded.
2. Secondary prevention:- it involves early diagnosis and case finding followed
by intervention to limit the disability.
• It includes early detection and treatment of preventable disorder which may lead to
mental retardation.
• Early detection and treatment of sensory motor and behavioural handicaps.
• Early treatment of correctable disorder.
• Early recognition of presence of mental retardation .
3. Tertiary prevention:-
 Aims to limit disability and promote rehabilitation:-
It includes:-
• Treatment of physical and psychological problems.
• Education in special schools , if educable.
• Vocational training , if trainable.
Learning disorders:-
Since the 1970s the field of learning disabilities has gradually
responded to research involving specific deficits involved in reading ,
written expression and mathematics. Learning problem must
significantly interfere with achievement at school or the performance
or activities in daily life that require reading,mathematics or writing
skills.
Definition :- The term learning disorder is to refer to a group of
disorders that are characterized by learning problems resulting in an
individuals measured academic achievement.
Types of learning Disorders:-
1. Reading disorder
2. Mathematics Disorders
3. Disorders of written Language
1.Reading disorder :- Reading disorder is known as DYSLEXIA. Disorder
is Reading achievement below the expected level for a child’s age , education
and intelligence with the impairment interfering significantly with academic
success or the daily activities.
Aetiology :-
1. Genetic Causes: it frequently occurs in family members.
2. Neurological causes: disorder of brain dysfunction.
3. Social factors : frequent changes of school ,home background.
Clinical features:-
1. Dyslexia is related to deficits in processing the basic sounds that
make up language, a skill that is referred to as that result in difficulty
with decoding .
2. Difficulty in developing an awareness that spoken and written
words.
3. Long pauses,use of fillers(UMM) and use of non specific filler e.g
that thing.
4. Slow reading
Management:-
Parental counselling :-
• Parents are helped to accept the child as he is.
• Provide practice in reading at home and listen to their reading.
Counselling and psychotherapy of child:-
• Positive reinforcement given immediately.
• Allowing child to their own program.
• Help with the emotional issues that rise from struggling to overcome
academic difficulties.
Mathematics disorders:-
 It is involves difficulties recognizing numbers and symbols , memorizing facts ,
etc. Define mathematics achievement below the expected level of child age.
 Difficulty in leaning arithmetic, numbers known as DYSCALCULIA.
Etiology :-
• Genetic cause may be involved .
• Abnormality in cerebral hemisphere.
• Environmental factor may also be involved.
Clinical features:-
• Mathematical symptoms.
• Attentional symptoms.
• Perceptual symptoms(difficulty in recognizing and reading numerical symbols)
Management:-
• Special class room placement of the child – it provides supplemented
remedial teaching.
• Cognitive developmental teaching.
• Encourage them to ask doubts.
• Providing demonstration, modelling and feedback.
• Teaching demonstration with permanent model.
Disorder of written language:- (Dysgraphia)
 Written expression is related to basic skills such as handwriting and spelling as well
as executive functions such as planning, self monitoring, organizing etc.
Aetiology :-
• Not known
• Possible causes are:
• Genetic , biological , psychosocial , environmental
Clinical features:-
• Spelling errors.
• Grammatical errors
• Excessively poor handwriting.
• Poor organization of paragraphs
Management:-
• Practice with writing .
• Consistently using a basic framework of planning, writing and
revision.
• Encourage proper grip and posture for writing.
• Be positive and patient , encourage practice and praise efforts.
• Allow extra time for writing.
• Counselling and psychotherapy of the child and parents.
 Pervasive developmental disorders
(PDD) :-
 Introduction :- The child is in a process of development throughout
childhood and delays in the development of socialization and
communication skills.
• In more than two third of children with PDD there is evidence of
development before the child is one year old.
• In other is evidence of regression in speech , language and communication
during the next six months and within two and half years for most children
with PDD except those with childhood disintegrative disorder.
• PDD Includes childhood Autism , Rett’s syndrome , Asperger’s syndrome
etc.
A. Autistic Disorder (Autism) :-
 Kenner (1943) described certain classified features which were the hallmark of
the condition designated as early infantile Autism, with an onset before 30
months of age though certain modifications were suggested over the years. The
following features are present:-
• Profound general failure of development of social relationships.
• These children did not be picked up,their eye to eye gaze was different and they
failure of maternal bonding and making friends.
• A marked retardation in acquiring language or even loss of already acquired
language .
• Stereotyped, repetitive movements of the hands and fingers .
• A short attention span with difficulty of maintaining the concentration in a
particular direction.
Cont..
• A delay in acquiring bladder and bowel control.
• A tendency to inflict self injury and enjoy the situation.
• Show compulsive behaviour .
Incidence:- Autistic disorder is relatively with an incidence of 10 per 10,000
children. The male female ratio for autistic disorder was 3:1 as found in studies .
Aetiology:-
• Psychosocial factors:- Kenner initially called as autism inborn disturbance,
emotionally rigid .
• Biological factors:- congenital rubella could be associated with the syndrome.
• Genetic factors:- may influence or contribute to development of autism.
Clinical features:-
 It is characterized by withdrawal of child into self and into a fantasy world of his or her own.
The child has markedly abnormal or impaired social interaction and communication. Following
features are seen:-
• Absent social simile.
• Lack of eye to eye contact
• Solitary play
• No attachment with parents and absence of separation anxiety.
• Inability to make friends
• Absence of fear in presence of danger.
• Impaired language and communication.
a. Lack of response to voice or sounds.
b. Absent speech.
c. Abnormal speech content and pattern like ECHOLALIA .
Treatment:-
 The treatment consists of three modes that may be used together
• Behaviour therapy :- it includes positive reinforcements to teach self care skills, speech therapy
and behavioural techniques to encourage interpersonal interactions.
• Psychotherapy:- parental counselling and supportive therapy are useful in allaying parental
anxiety.
• Pharmacotherapy:- Antipsychotic , Naltrexone , clonidine ,etc.