Mental retardation


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Mental retardation

  1. 1. Mental RetardationMental retardation begins in childhood or adolescents before the age of 18. Inmost cases, it persists throughout adulthood. A diagnosis of mental retardation ismade if an individual has an intellectual functioning level well below average andsignificant limitations in two or more adaptive skills. Intellectual functioning levelis defined by standardized test that measure the ability to reason in terms ofmental age (intelligence quotient or IQ). In general, mental retarded childrenreach developmental milestones such as walking and talking much later than thegeneral population. Symptoms of mental retardation are not diagnosed before thechild enters preschool. These children typically leave difficulties with social,communication and functional academic skills. Children who have a neurologicaldisorder or illness such as encephalitis or meningitis may suddenly show signs ofcognitive impairment and adaptive skills.PrevalenceCases of Mental Retardation are found in all societies of the world. Globally, theprevalence of MR is estimated to be around 30 per thousand. Almost 75% of thepopulation diagnosed as mentally retardation, while the remaining 25% haveeither moderate or sever and profound grade retardation.According to the WHO (1994) : approximately 156 million people or 3% of theworld’s population have mental retardation.According to the National Sample Survey Organization (NSSO), in 1991, out of1000 children in the rural area 9 out of every 1000 children were developmentaldelays, whereas in urban areas 9 out of every 1000 children are developmentallydelayed. The survey was conducted on children within the age group of 0-14years. On an average it is found that 2.5% of all such children are mild andmoderately retarded, and 0.5% have severe or profound retardation. The NSSOsurvey estimates that in the rural areas the prevalence of mental retardation is3.1% whereas it is much less at 0.9% in urban settings.Mental retardation was observed to have national rate of 42 per1000. Males are more likely than females to be mentallyretarded at a 1:5:1 ratio.The overall prevalence of mental retardation is believed to bebetween 1% and 3% with mild retardation being mostprevalent. It is often caused be chromosomal abnormalities suchas Down Syndrome, Fragile X Syndrome and Prader- Willi FRAGILE XSyndrome. SYNDROME 1Sangath; Porvorim Goa; Alisha DiasSHAPE Project 2009
  2. 2. Mental retardation occurs in 2.5-3% of the general population. About 6-7.5million mentally retarded individuals live in the United States alone.MR is defined as IQ below 70-75. Adaptive skills are the skills needed for dailylife. Such skills include the ability to produce and understand language(communication): home-living skills; use of community resources; health, safety,leisure, self-care and social skills; self direction; functional academic skills (reading,writing, and arithmetic; and work skills.Classification of Mental RetardationLevel of Retardation WHO DSM-IVMild retardation 50-69 50-70 EducableModerate retardation 35-49 35-55 TrainableSevere retardation 20-34 20-40 CustodialProfound Retardation Below 20 Under 20-25 CustodialMental retardation is a delay, or slowness, in achilds mental development. The child learnsthings more slowly than other childrenhis age. He may be late at beginning to move,smile, show interest in things, use his hands, sit,walk, speak, and understand. Or he maydevelop some of these skills more quickly, butbe slower in others.Mental retardation ranges from mild to severe.The child who is mildly retarded takes longer tolearn certain skills. But with help he can growup to care for himself and take an active,responsible part in the community. The childwho is severely retarded, as he grows older,may stay at the mental age of a baby or youngchild. He will always need to be cared for insome ways.Mental retardation cannot be cured. However,all mentally retarded children can behelped to progress more quickly. Theearlier special help or stimulationbegins, the more ability the child islikely to gain. 2Sangath; Porvorim Goa; Alisha DiasSHAPE Project 2009
  3. 3. However, mental retardation is only one of the reasons for slowdevelopment in children. A child who is blind will be slow in learning toreach and move about unless he has extra help and encouragement. A child whois deaf will be delayed in learning to communicate unless he is helped to learn totalk in other ways than speech. A child who has a severe physical disability isoften slow in developing use of both his body and mind.CAUSESThere are many causes.Often the cause is not known.Some children are born with a very small brain, or the brain does not grow orwork normally.Sometimes there is a mistake in the chromosomes or the tiny chemicalmessages that determine what a child will be like (inheritance). This is whathappens in Down syndrome.Sometimes a mother did not get enough of a certain food or mineralduring pregnancy.Brain damage can happen either before,during, or after birth. In addition to beingretarded, these children may also have cerebralpalsy, blindness, deafness, or fits.• German measles during early pregnancy.• meningitis (brain infection) from bacteria,tuberculosis, or malaria, most often during earlychildhood• hydrocephalus, often with spina bifida• head injuries• other causes include brain tumor,poisoning from lead, pesticides, certainmedicines and food, and some forms ofmuscular dystrophy or atrophy.Child with microcephaly (small brain) is mentally slow and often also developscertain physical problems. For measurements of head size.In many parts of the world, the most common causes of mental retardation arebrain damage and Down syndrome. But in some mountainous areas, it is veryoften caused by lack of iodine in food and water.Usually there is no treatment for mental retardation. Therefore, weoften do not need to know the exact cause. Instead, we need to help the child 3Sangath; Porvorim Goa; Alisha DiasSHAPE Project 2009
  4. 4. develop the best he can. However, in some cases, certain medicines, changes indiet, or prevention of further poisoning can make a big difference. If a child hasany signs of cretinism or seems to be gradually losing mental ability, try to getexpert medical advice.DOWN SYNDROME In many areas, Down syndrome-or mongolism-is the most common form of mental slowness, or retardation. These children are slower than others in learning to use their bodies and their minds. There are also certain physical signs or problems. (This combination of various signs is called a syndrome.) The baby does not develop normally in the womb because of an error in the chromosomes (material in each cellof the body that determines what a baby will be and looklike).These are the typical signs of Down (but not all the children have all thesesigns): • • At birth, baby seems floppy and weak. • Baby does not cry much. • The baby is slower than other babies her age to: turn over, grasp things, sit up, talk, and walk. • When suddenly lowered, the baby does not react by spreading her arms, as a normal baby does. • eyes slant upward; sometimes cross-eyed or poor sight • ears low • small mouth, hangs open; roof of mouth is high and narrow; tongue hangs out • A fold of skin covers the inner corner of the eyelid. • Eyelids may be swollen and red. 4Sangath; Porvorim Goa; Alisha DiasSHAPE Project 2009
  5. 5. • The iris of the eye has many little white specks; like sand. These usually go away by 12 months of age. • short wide hands with short fingers. The little finger may be curved, or have only one fold. • one deep crease across the palm (sometimes in normal children, too) • Short or small head, wide and flat in the back • Sometimes dislocated hips • Flat face • Small nose, flat between the eyes • short neck • rounded shoulders • short arms and legs • kneecap slips to one side • pigeon-toed; flat feet • big toe far apart from other toesOther possible signs: • Elbow, hip, and ankle joints may be very loose and flexible. • One out of 3 has heart problems. • May develop leukemia (blood cancer). • Check older children for hearing and seeing problems. • One out of 10 has deformed neck bones which can slip and pinch the nerve cord in the spine. This may cause sudden or slowly increasing paralysis -or sudden death.Some children with Down syndrome can go to school, but they will need extrahelp. It is important that teachers understand their problem and help otherchildren to treat the retarded child with respect. Unless the child is givenunderstanding and extra help at school, in rural areas it may sometimes be betterfor the child with Down syndrome to be educated at home through helping hisfamily around the house and in the fields.There are 3 main concerns in caring for a child with Down syndrome: 1. Help the child to develop her or his mental and physical abilities. 2. Protect the child from infectious diseases. 3. Prevent or correct deformities.PREVENTION of Down syndromeOne out of every 800 children is born with Down and it occurs more commonlywith mothers under 20 and over 35 years of age. Women over 40 (or even over 5Sangath; Porvorim Goa; Alisha DiasSHAPE Project 2009
  6. 6. 35) may want to consider not having more children. Also, if a couple already hasone Down child, the chance of having another is higher than normal (about onein 50).In some countries a test (amniocentesis) can be done at about 4 months ofpregnancy to see if the child will have Down syndrome. If so, the family canconsider abortion (in societies where this is permitted).Cretinism (Hypo-Thyroidism)Cretinism is a delay in both mental and physical growth that comes when a childsbody does not produce enough thyroid. Thyroid is asubstance, or hormone, that controls a childs growthand body functions. Without it, everything goesslower.Thyroid is produced by a gland in the front of theneck. To produce thyroid, the gland needs iodine.Most people get enough iodine from water and food.But in some areas, especially in the mountains, the soil, water, and food have verylittle iodine. In an attempt to obtain more iodine, the thyroid gland sometimesgrows very large, forming a swelling called a goiter.In areas where there is little iodine and a lot of people have goiters, cretinism iscommon. In these same areas, often many children have difficulty hearing orare somewhat retarded mentally. Although they do not show all the typicalsigns of cretinism, the cause is probably the same. Occasionally, in areas wheregoiter is not common, cretinism occurs for other reasons than lack of iodine.SIGNS Below we show some of the typical signs of cretinism and compare themwith Down syndrome, which cretinism resembles in some ways. It is often difficultto tell if a newborn baby has cretinism. She is often born large and then fails togrow normally. The baby may have feeding difficulties, or breathing difficulties ormake noises because of the large tongue. She moves and cries little. By 3 to 6 6Sangath; Porvorim Goa; Alisha DiasSHAPE Project 2009
  7. 7. months the mother often becomes worried because the baby looks dull, takes solittle interest in things, sleeps so much, and is slow in all areas of development. Signs of CRETINISM • temperature below normal • thick, dry, cool skin • hair low on forehead • puffy eyelids • flat base of nose between eyes • puffy face, hands, and feet • fatty swelling here • grows very slowly. • Increasingly short for age. • severe constipation (may go days without shitting) • often deafness • As child grows, knees may get large and painful. Signs seen in both CRETINISM AND DOWN  slow mental and physical development  widely separate eyes  round face, dull look tongue sticks out of open mouth  short neck and limbs; wide, short hands  big belly and swayback  often hernia of the navel Signs of DOWN SYNDROME (that are most useful in telling it from cretinism) • hair starts high on forehead 7Sangath; Porvorim Goa; Alisha DiasSHAPE Project 2009
  8. 8. • slant eyes with lid fold over inner cornersWHAT TO DO Early and continued treatment with thyroid medicine helpsimprove growth, physical appearance, and sometimes can reduce or preventmental retardation. For best results, treatment should begin during the first monthof life. For this reason, as soon as you suspect that a baby might havecretinism, get skilled medical advice.With early treatment and guided learning, many children with cretinism can learnto care for themselves and do simple but important work in the communityPREVENTION In areas where goiter is common, cretinism (and deafness) can begreatly reduced by encouraging everyone to use iodized salt. 8Sangath; Porvorim Goa; Alisha DiasSHAPE Project 2009