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MENTAL
RETARDATIO
N
Presented By:
Mr. Navjyot Singh Choudhary
M.Sc.(Nursing) Final Year
Dept. of Pediatric Nursing
Definition
“Mental retardation refers to significantly
subaverage general intellectual functioning
resulting in or associated with concurrent
impairments in adaptive behavior &
manifested during the developmental
period”
Epidemiology
 About 3% 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 & profound mental retardation
mortality is high due to associated physical
disease.
Etiolo
gy

Genetic
Factors

Genetic
Factors

Chromosomal
abnormalities

Metabolic disorders

 Down’s syndromes
 Fragile X syndrome
 Trisomy X syndrome
 Turner’s syndrome

 Phenylketonuria
 Wilson’s disease

 Galactosemia

 Cat-cry syndrome

Gross disease of brain

 Prader-willi syndrome

 Tuberous scleroses

Cranial malformation

 Neurofibromatosis

 Hydrocephaly

 Epilepsy
Prenatal Factors
Infection
 Cytomegalovirus

Physical damage &
disorders
 Injury

 Syphilis

 Hypoxia

 Toxoplasmosis, herpes

 Radiation

simplex
Endocrine
disorders
 Hypothyroidism
 Hypoparathyrodism
—
 Diabetes mellitus

 Hypertension

Intoxication

 Nutrition growth retardation

 Rubella

 Anemia
 Emphysema

Placental dysfunction
 Toxemia of pregnancy
 Placenta previa

 Cord prolapse
Perinatal Factors

 Environmental & socio-cultural

 Birth asphyxia
 Prolonged or difficult



birth
 Prematurity
 Kernicterus
 Instrumental delivery
Postnatal Factors



 Infections

Encephalitis
ii. Measles
iii. Meningitis
iv. Septicemia
i.

 Accidents
 Lead poisoning




Factors
Cultural deprivation
Low socio-economic status
Inadequate caretakers
Child abuse
Classification:
 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% 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 &
absent or markedly delayed speech & communication
skills.

Profound Retardation (IQ below 20)
This group accounts for 1-2% of all
mentally retarded. The achievement of developmental
milestones is markedly delayed. They require constant
nursing care & supervision.
SIGN AND SYMPTOMS
 Failure to achieve developmental

milestones
 Deficiency in cognitive functioning such
as inability to follow commands or
directions
 Failure to achieve intellectual
developmental markers
 Reduced ability to learn or to meet
academic demands
 Expressive or receptive language
 Psychomotor skill deficits
 Difficulty performing self-esteem
 Irritability when frustrated or upset
 Depression or labile moods
 Acting-out behavior
 Persistence of infantile behavior

 Lack of curiosity.
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 evaluation
 EEG, especially if seizure are present

 CT scan or MRI brain, for example, in tuberous

sclerosis
 Thyroid function tests when cretinism is
suspected
 Psychological tests like Stanford Binet
Intelligence Scale & Wechsler Intelligence Scale
for Children’s (WISC), for categorizing the child’s
level of disability.
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 & deal with guilt
or anger.
Early intervention programs for children younger than 3 with mental
retardation
Provide day schools to train the child in basic skills, such as bathing
NURSING MANAGEMENT
 Determine the child’s strengths & abilities & develop a plan

of care to maintain & enhance capabilities.
 Monitor the child’s developmental levels & initiate
supportive 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 if self-injury
occurs.
 Monitor the child for physical or emotional distress.
 Teach the child adaptive skills, such as eating,

dressing, grooming & toileting.
 Demonstrate & help him practice self-care skills.
 Work to increase his compliance with conventional
social norms & behaviors.
 Maintain a consistent & supervised environment.
 Maintain adequate environmental stimulation.
 Set supportive limits on activities.
 Work to maintain & enhance his positive feelings about
self & daily accomplishments.
PROGNOSIS
 The prognosis for children with metal retardation

has improved & institutional care is no longer
recommended.
 These children are mainstreamed whenever
feasible & are taught survival skills.
 A multidimensional orientation is used when
working with these children, considering their
psychological, cognitive, social & emotional
development.
THANK YOU

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Mental retardation

  • 1. MENTAL RETARDATIO N Presented By: Mr. Navjyot Singh Choudhary M.Sc.(Nursing) Final Year Dept. of Pediatric Nursing
  • 2. Definition “Mental retardation refers to significantly subaverage general intellectual functioning resulting in or associated with concurrent impairments in adaptive behavior & manifested during the developmental period”
  • 3. Epidemiology  About 3% 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 & profound mental retardation mortality is high due to associated physical disease.
  • 4. Etiolo gy Genetic Factors Genetic Factors Chromosomal abnormalities Metabolic disorders  Down’s syndromes  Fragile X syndrome  Trisomy X syndrome  Turner’s syndrome  Phenylketonuria  Wilson’s disease  Galactosemia  Cat-cry syndrome Gross disease of brain  Prader-willi syndrome  Tuberous scleroses Cranial malformation  Neurofibromatosis  Hydrocephaly  Epilepsy
  • 5. Prenatal Factors Infection  Cytomegalovirus Physical damage & disorders  Injury  Syphilis  Hypoxia  Toxoplasmosis, herpes  Radiation simplex Endocrine disorders  Hypothyroidism  Hypoparathyrodism —  Diabetes mellitus  Hypertension Intoxication  Nutrition growth retardation  Rubella  Anemia  Emphysema Placental dysfunction  Toxemia of pregnancy  Placenta previa  Cord prolapse
  • 6. Perinatal Factors  Environmental & socio-cultural  Birth asphyxia  Prolonged or difficult  birth  Prematurity  Kernicterus  Instrumental delivery Postnatal Factors   Infections Encephalitis ii. Measles iii. Meningitis iv. Septicemia i.  Accidents  Lead poisoning   Factors Cultural deprivation Low socio-economic status Inadequate caretakers Child abuse
  • 7. Classification:  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% of mentally retarded come under this group.
  • 8. Severe Retardation (IQ 20-35) Severe mental retardation is often recognized early in life with poor motor development & absent or markedly delayed speech & communication skills. Profound Retardation (IQ below 20) This group accounts for 1-2% of all mentally retarded. The achievement of developmental milestones is markedly delayed. They require constant nursing care & supervision.
  • 9. SIGN AND SYMPTOMS  Failure to achieve developmental milestones  Deficiency in cognitive functioning such as inability to follow commands or directions  Failure to achieve intellectual developmental markers  Reduced ability to learn or to meet academic demands  Expressive or receptive language
  • 10.  Psychomotor skill deficits  Difficulty performing self-esteem  Irritability when frustrated or upset  Depression or labile moods  Acting-out behavior  Persistence of infantile behavior  Lack of curiosity.
  • 11. 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 evaluation
  • 12.  EEG, especially if seizure are present  CT scan or MRI brain, for example, in tuberous sclerosis  Thyroid function tests when cretinism is suspected  Psychological tests like Stanford Binet Intelligence Scale & Wechsler Intelligence Scale for Children’s (WISC), for categorizing the child’s level of disability.
  • 13. 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 & deal with guilt or anger. Early intervention programs for children younger than 3 with mental retardation Provide day schools to train the child in basic skills, such as bathing
  • 14. NURSING MANAGEMENT  Determine the child’s strengths & abilities & develop a plan of care to maintain & enhance capabilities.  Monitor the child’s developmental levels & initiate supportive 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 if self-injury occurs.  Monitor the child for physical or emotional distress.
  • 15.  Teach the child adaptive skills, such as eating, dressing, grooming & toileting.  Demonstrate & help him practice self-care skills.  Work to increase his compliance with conventional social norms & behaviors.  Maintain a consistent & supervised environment.  Maintain adequate environmental stimulation.  Set supportive limits on activities.  Work to maintain & enhance his positive feelings about self & daily accomplishments.
  • 16. PROGNOSIS  The prognosis for children with metal retardation has improved & institutional care is no longer recommended.  These children are mainstreamed whenever feasible & are taught survival skills.  A multidimensional orientation is used when working with these children, considering their psychological, cognitive, social & emotional development.