This document discusses mental retardation, including its classification, definition, causes, diagnosis, prevention, and care. Some key points:
- Mental retardation is classified based on severity from mild to profound. It is defined as subaverage intellectual functioning and deficits in adaptive skills that manifest before age 18.
- The leading causes are genetic factors (5%), complications during pregnancy/childbirth (15%), socioeconomic deprivation (15%), and unknown factors (58%).
- Diagnosis involves assessing intellectual functioning, adaptive skills, and ruling out other conditions through tests, exams, and medical history.
- Prevention strategies include genetic counseling, prenatal care, early detection/treatment, and rehabilitation services tailored to needs. Care requires
3. Definition
Significantly subaverage general intellectual
functioning, associated with significant deficit or
impairment in adaptive functioning, which manifests
during the developmental period
- American association (1983)
4. • A condition of arrested or incomplete
development of the mind, characterized by
impairment of skills manifested during
developmental period that contribute to
cognitive, language, motor and social abilities.
– ICD-10
5. • Intellectual functioning – Result of
standardized Intelligence Tests
• Subaverage – Below 70 IQ
• Adaptive behavior – Ability to meet the
responsibilities of social, personal,
occupational and interpersonal areas of life
according to his age and socio cultural
background
• Developmental Period – Below 18 years
6. INCIDENCE AND PREVALENCE
• 3% of the world population is estimated to be
mentally retarded
• 20 million children are suffering with MR
• Boys are more suffering than girls
• Mortality is high in severe or profound MR
• Common in 2-3 years, peak in 10-12 years
9. Causes of Mental Retardation
I. Genetic Causes
II. Perinatal Causes
III. Acquired Physical Disorders in childhood
IV. Socio cultural causes
V. Psychiatric disorders
10. I. Genetic Causes (5% of the cases)
• Chromosomal Abnormalities
Down’s syndrome
Fragile- X Syndrome
Turner’s Syndrome
Klienfelter’s Syndrome
• Inborn Errors of Metabolism
Phenyl Ketonuria, Neimann- Pick Disease
• Single – Gene Disorders
Tuberous Sclerosis, Neurofibromatosis
• Cranial Anomalies
Microcephaly, Macrocephaly
11. II. Perinatal Causes(10% of cases)
• Infections (TORCH)
• Prematurity
• Birth Trauma
• Hypoxia
• Intrauterine Growth Retardation
• Kernicterus
• Placental abnormalities
• Drugs used during first trimester
12. III. Acquired Physical Disorders in
Childhood (2-5% of cases)
• Infections
• Cretinism
• Trauma
• Lead Poisoning
• Cerebral Palsy
13. IV. Socio Cultural Causes (15% of cases)
Deprivation of socio cultural stimulation
14. V. Psychiatric Disorders
(1 – 2% of cases)
• Pervasive Developmental Disorder
Infantile Autism
• Childhood Onset Schizophrenia
16. Mild Mental Retardation
• Commonest type
• Accounts for 85 – 90% of all cases
• Minimal retardation in sensory - motor areas
• They can progress up to VI standard
• They can achieve vocational skills
17. Mild Mental Retardation (Educable)
• They can achieve social self-sufficiency
• They can develop social and communication
skills
• But they have deficits in cognitive function like
poor ability for abstraction and egocentric
thinking
18. Moderate Mental Retardation (Trainable)
• Accounts for 10% of all cases
• They have poor social awareness during early
years
• Communication skills develop very slowly in
these individuals
• They drop out of school after 2nd Grade
• They can be trained to perform semi skilled
or unskilled work under supervision
• Even mild stress can destabilize them.
19. Severe Mental Retardation (Dependent)
• Recognized early in life
• Significantly delayed developmental mile stones
• Absent or markedly delayed speech or communication
skills
• Self care (ADL) can be taught
• They can perform very simple tasks under supervision
• They require a great amount of assistance for living
• They require a structured environment
20. Profound Mental Retardation ( Custodial Care)
• Accounts for 1-2% of all cases
• Often associated with physical disorders
• Marked delay in developmental milestones
• They need nursing care or life support
• Usually cared in a residential setting
21. Diagnosis
• History collection from Parents and Care Takers
• 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
22. Diagnosis
• Hearing and speech evaluation
• EEG, especially seizures present
• CT scan or MRI brain (Tuberous sclerosis)
• Thyroid function test (Cretinism)
• Psychological Tests
– Stanford Binet Intelligence Test
– Wechsler Intelligence Scale for Children (WISC)
25. Primary Prevention
• Preconception:
Genetic counseling
Immunization for maternal rubella
Blood tests for marriage
Adequate maternal nutrition
Family Planning (Size, Appropriate spacing, and
age of parents)
27. A. Prenatal Care
• Adequate nutrition, fetal monitoring and
protection from disease
• Avoidance of teratogenic substances like
exposure to radiation and consumption of alcohol
and drugs
28. B. Analysis of fetus
• Amniocentesis
• Fetoscopy
• Fetal biopsy
• Ultrasound
29. At Delivery
• Delivery conducted by expert doctors and
staff, especially in cases of high-risk pregnancy
• APGAR score done at 1 and 5 minutes after
the birth of the child
• Close monitoring of mother and child
• Injection of Gamma globulin, which can
prevent Rh-negative mothers from developing
antibodies that might otherwise affect
subsequent children
30. Childhood
• Proper nutrition throughout the developmental
period and particularly during the first 6 months
after birth
• Dietary restrictions for specific metabolic disorders
until no longer needed
• Avoidance of hazards in the child’s environment to
avert brain injury from causes such as lead
poisoning, ingestion of chemicals or accidents
31. Secondary Prevention
• Early detection and treatment of
preventable disorders
• Early recognition of presence of
mental retardation – A delay in
diagnosis may cause unfortunate
delay in rehabilitation
• Psychiatric treatment for emotional
and behavioural difficulties
32. Tertiary Prevention
• Rehabilitation in vocational, physical and
social areas according to the level of
handicap.
• Rehabilitation is aimed at reducing
disability and providing optimal
functioning in a child with mental
retardation
34. Care and Rehabilitation of the
Mentally Retarded Child
Main Elements in a comprehensive service:
1. Prevention and early detection of mental handicaps
2. Regular assessment of the mentally retarded
3. Advice, support, and practical measures for families
4. Provision for education, training, occupation or
work appropriate for each handicapped person
5. Housing and social support to enable self-care
6. Medical, nursing and other services
7. Psychiatric and psychological services
35. Care of a Mentally retarded child
• Team approach
• Fostering (bring up)
• Boarding school / residential care
• Special education and training
• Vocational training
• Help for families
• Residential care
• Specialist medical services
• Psychiatric services
36. Hints for successful skill training…
• Divide each activity into small steps and
demonstrate
• Give repeated training in each activity
• Give the training regularly and
systematically
• Start the training with what the child knows
and proceed to what to be trained
• Reward his effort / task achievement
37. Hints for successful skill training…
• Reduce the reward gradually as he masters a
skill and move on to next skill
• Use the available training material
• Sibling relationship – learning
• No age limit for training
• Periodically assess the child
(Once in 6 months)
• Child learns very slowly
