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Mental retardation

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  • 1. MR. JAYESH PATIDARwww.drjayeshpatidar.blogspot.comMENTALRETARDATION
  • 2. Definition “Mental retardation refers to significantlysubaverage general intellectual functioningresulting in or associated with concurrentimpairments in adaptive behavior & manifestedduring the developmental period”(American Association on MentalDeficiency,1983).Significant subaverage is defined as anIntelligence Quotient (IQ) of 70 or below onstandardized measures of intelligence. Theupper limit is intended as a guideline & could beextended to 75 or more, depending on the 5/7/2013JAY PATIDAR (€M.Sc. NURSING)
  • 3. Count… General intellectual functioning is defined as theresult obtained by the administration of standardizedgeneral intelligence tests developed for the purpose, &adopted to the conditions of the region/country. Adaptive behavior is defined as the degrees withwhich the individual meets the standards of personalindependence & social responsibility expected of hisage & cultural group. The expectations of adaptivebehavior vary with the chronological age. The deficits inadaptive behavior may be reflected in the followingareas:During infancy & childhood• Sensory & motor skill development• Communication skill (including speech & language)• Self-help skills 5/7/2013JAY PATIDAR (€M.Sc. NURSING)
  • 4. Count…During childhood & adolescence• Application of basic academic skill to daily lifeactivities• Application of appropriate reasoning & judgment inthe mastery of the environment• Social skills.During late adolescence• Vocational & social responsibilities & performanceDevelopmental periods is defined as the period oftime between conception & the 18th birthday.5/7/2013JAY PATIDAR (€M.Sc. NURSING)
  • 5. Epidemiology About 3% of the world population is estimatedto be mentally retarded. In India, 5 out of 1000 children are mentallyretarded (The Indian Express, 13th March2001). Mental retardation is more common in boysthan girls. With severe & profound mental retardationmortality is high due to associated physicaldisease.5/7/2013JAY PATIDAR (€M.Sc. NURSING)
  • 6. EtiologyGenetic Factors Chromosomalabnormalities Down’s syndromes 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 disease of brain Tuberous scleroses Neurofibromatosis Epilepsy5/7/2013JAY PATIDAR (€M.Sc. NURSING)
  • 7. Count…Prenatal Factors Infection Rubella Cytomegalovirus Syphilis Toxoplasmosis, herpessimplex Endocrine disorders Hypothyroidism Hypoparathyrodism Diabetes mellitus Physical damage &disorders Injury Hypoxia Radiation Hypertension Anemia Emphysema Intoxication Lead & certain drug Substance abuse Placental dysfunction Toxemia of pregnancy Placenta previa Cord prolapse Nutrition growth retardation5/7/2013JAY PATIDAR (€M.Sc. NURSING)
  • 8. Count…Perinatal Factors Birth asphyxia Prolonged or difficult birth Prematurity (due tocomplications) Kernicterus Instrumental delivery(resulting in head injury,intraventricular hemorrhage)Postnatal Factors Infections Encephalitis Measles Meningitis Septicemia Accidents Lead poisoningEnvironmental & socio-cultural Factors Cultural deprivation Low socio-economicstatus Inadequate caretakers Child abuse5/7/2013JAY PATIDAR (€M.Sc. NURSING)
  • 9. Classification: Mild Retardation (IQ 50-70)This is commonest type ofmental retardation accounting for 85-90% of allcases. These individuals have minimumretardation in sensory-motor areas. Moderate Retardation (IQ 35-50)About 10% of mentally retardedcome under this group.5/7/2013JAY PATIDAR (€M.Sc. NURSING)
  • 10. Count… Severe Retardation (IQ 20-35)Severe mental retardation isoften recognized early in life with poor motordevelopment & absent or markedly delayedspeech & communication skills. Profound Retardation (IQ below 20)This group accounts for 1-2% of all mentally retarded. The achievement ofdevelopmental milestones is markedly delayed.They require constant nursing care & supervision.5/7/2013JAY PATIDAR (€M.Sc. NURSING)
  • 11. SIGN AND SYMPTOMS Failure to achievedevelopmentalmilestones Deficiency in cognitivefunctioning such asinability to followcommands or directions Failure to achieveintellectualdevelopmental markers Reduced ability to learnor to meet academicdemands Expressive or receptive Psychomotor skilldeficits Difficulty performingself-esteem Irritability whenfrustrated or upset Depression or labilemoods Acting-out behavior Persistence of infantilebehavior 5/7/2013JAY PATIDAR (€M.Sc. NURSING)
  • 12. DIAGNOSIS History collection from parents & caretakers Physical examination Neurological examination Assessing milestones development Investigations– Urine & blood examination for metabolic disorders– Culture for cytogenic & biochemical studies– Amniocentesis in infant chromosomal disorders– chorionic villi sampling– Hearing & speech evaluation5/7/2013JAY PATIDAR (€M.Sc. NURSING)
  • 13. Count… EEG, especially if seizure are present CT scan or MRI brain, for example, in tuberoussclerosis Thyroid function tests when cretinism is suspected Psychological tests like Stanford Binet IntelligenceScale & Wechsler Intelligence Scale for Children’s(WISC), for categorizing the child’s level of disability.5/7/2013JAY PATIDAR (€M.Sc. NURSING)
  • 14. PROGNOSIS The prognosis for children with metalretardation has improved & institutional care isno longer recommended. These children are mainstreamed wheneverfeasible & are taught survival skills. A multidimensional orientation is used whenworking with these children, considering theirpsychological, cognitive, social & emotionaldevelopment.5/7/2013JAY PATIDAR (€M.Sc. NURSING)
  • 15. TREATMENT MODALITIES Behavior management Environmental supervision Monitoring the child’s development needs & problems. Programs that maximize speech, language, cognitive,psychomotor, social, self-care, & occupational skills. Ongoing evaluation for overlapping psychiatric disorders,such as depression, bipolar disorder, & ADHD. Family therapy to help parents develop coping skills & dealwith guilt or anger. Early intervention programs for children younger than 3 withmental retardation Provide day schools to train the child in basic skills, such asbathing & feeding. Vocational training.5/7/2013JAY PATIDAR (€M.Sc. NURSING)
  • 16. NURSING INTERVENTION Determine the child’s strengths & abilities &develop a plan of care to maintain & enhancecapabilities. Monitor the child’s developmental levels & initiatesupportive interventions, such as speech,language, or occupational skills as needed. Teach him about natural & normal feelings &emotions. Provide for his safety needs. Prevent self-injury. Be prepared to intervene ifself-injury occurs. Monitor the child for physical or emotionaldistress. Modify his behavior by having him redirect hisenergy. 5/7/2013JAY PATIDAR (€M.Sc. NURSING)
  • 17. Count… Teach the child adaptive skills, such as eating,dressing, grooming & toileting. Demonstrate & help him practice self-care skills. Work to increase his compliance with conventionalsocial norms & behaviors. Maintain a consistent & supervised environment. Maintain adequate environmental stimulation. Set supportive limits on activities. Work to maintain & enhance his positive feelingsabout self & daily accomplishments.5/7/2013JAY PATIDAR (€M.Sc. NURSING)
  • 18. THANKYOU5/7/2013JAY PATIDAR (€M.Sc. NURSING)