1. S . D. Bulathsinghala
Special Grade Nursing Tutor
School of Nursing Mental
Health
Mulleriyawa
2. Intellectual or developmental disabilities.
However, it's important to note that the term
"mental sub normality" is an outdated and
potentially offensive term that is no longer used in
professional healthcare contexts. Instead,
contemporary healthcare professionals use more
respectful and clinically appropriate terminology to
describe conditions related to intellectual or
developmental disabilities.
3. Lesson Plan
Name of the Presenter - Mrs. S.D Bulathsinghala
Subject - Psychiatric Nursing
Topic - Mental sub normality
Participants -Nursing student(diploma)
Time - 3 hours
Teaching activity - Lecturer ,discussion
Evaluation -Answering the questions
4. General Objectives
At the end of this session Nursing students should be able to
appreciate the knowledge when caring of the patient with
mental sub normality
Specific Objectives
After Completion of this lesson nursing students will be able to
.Define mental sub normality
. Describe intellectual function and adaptive functioning
,
5. Specific objectives Cont….
Describe signs of developmental delay
Describe causes for mental sub normality .
Describe, diagnostic evaluation and management
of sub normality
List out the classification of mental sub normality
6. Specific Objectives cont…
Describe, diagnostic evaluation and management of
sub normality
List out the classification of mental sub normality
Describe the preventive methods of sub normality
Appreciate the nursing care and rehabilitation of sub
normality
7. Mental sub normality
Mental sub normality or Mental retardation is a state
of developmental deficit that begins in childhood and
result in significant limitation of intellect and poor
adaptation to the demands of every day life
8. Mental retardation refers to significantly sub-average
general intellectual functioning resulting in or
associated with concurrent impairments in adaptive
behavior and manifested during the developmental
period
(American Association on Mental Deficiency 1983)
9. Mental retardation is
defined by deficits in
general intellectual
functioning and adaptive
functioning (APA, 2000)
10. several terms have been used to denote this condition
such as ,
•Mental sub normality
•Mental retardation
•mental handicap,
•mental deficiency
•Mental impairment
12. Mental Sub Normality is not a disease but a condition in
which….lack of General intellectual functioning and
adaptive functioning
It presents from birth – developmental period (birth – 18
years) Developmental delays are failure to achieve age-
appropriate skills) are evident to some degree in almost all
areas.
Motor developmental delays
Cognitive developmental delay
13. Adaptive functioning
Refers to the person’s ability to adapt to the requirements of
daily living and the expectations of his or her age and cultural
group.
• Ex -Being able to communicate effectively
• Interact with others
• Take care of one self.
• Daily living skills at home ,in the community . Or social skills
14. Intellectual functioning is determined by many factors.
However, a primary source of this capacity is mental
ability or "intelligence."
Intelligence refers to the ability to reason, plan, think, and
communicate.
These abilities allow us to solve problems, to learn, and to
use good judgment.
15. Intellectual disability involves problems with general
mental abilities that affect functioning in two areas:
Intellectual functioning (such as learning, problem
solving, judgments)
Adaptive functioning (activities of daily life such as
communication and independent living)
17. General intellectual functioning
is measured by an individual’s performance
on intelligence quotient (IQ) tests.
Intelligence quotient
(IQ ) tests = Mental Age (MA ) x 100
Chronological Age (CA)
18. How can I know my mental age?
Mental age, intelligence test score, expressed as the
chronological age for which a given level of
performance is average or typical.
An individual's mental age is then divided by his
chronological age and multiplied by 100, yielding an
intelligence quotient (IQ).
19. SIGNS OF DEVELOPMENTAL DELAY
Infancy
Poor feeder, a weak or uncoordinated suck
Results in poor breast- or bottle-feeding,
leading to poor weight gain
Delayed or decreased visual alertness and
Curiosity with poor visual tracking of face or
objects
20. SIGNS OF DEVELOPMENTAL DELAY
CONT…..
Communication and Feeding
Feeding difficulties weak sucking or poor coordination of
suck-swallowing to sustain normal weight gain
No social smile by age 4 months
No babbling (ga-ga, da-da) by age 9 months
No Mama, Dada (specific) by age 14 months
21. Cont…….
No name of object (one word) by age 14 months
At least 10 words by age 18 months (not just repeating)
•Combines words (eg, me outside, more milk) and
uses pronouns by age 24 months
•Regression in language at any age
•Unresponsive to his name
22. Cont…..
Motor Delay
Not rolling over by age 6 months
Not sitting by age 9 months
Not walking by age 15 months
Not stair-climbing by age 2 years
23. Most Common Types of Intellectual
Disabilities
Autism. Autism is an intellectual disability
affecting the nervous system and the
structure and function of the brain. ...
Down's Syndrome. ...
Fragile X Syndrome. ...
Fetal Alcohol Syndrome. ...
Prader-Willi Syndrome (PWS)
24. •Genetic factors
•Chromosomal disorders
Eg: Down’s syndrome,
Turner syndrome is a genetic disorder found in
females.
•Metabolic disorders
Eg: Phenylketonuria, Wilson’s disease
•Cranial malformations
Hydrocephaly , Microcephaly
Causes for Mental Sub normality
25. Pre natal factors (from conception to birth)
•Infections (Torches)
• Endocrine disorders
Ex: Diabetic mellitus, Hypothyroidism
•Physical damage and disorders
Ex : Injury, Hypoxia, Hypertension, Anemia, heart and
kidney disease
29. Postnatal factors cont.….
•Hypoglycemia
• Neonatal convulsion
• Head injury
• Lead poisoning
• Severe prolonged malnutrition
30. Classification of Mental Sub normality
Mental retardation comprises five general
categories:
Mild mental Sub normality
Moderate mental Sub normality
Severe mental Sub normality
Profound mental Sub normality
31. Classification of Mental Sub normality
Mild (educable) 50-70%
Moderate (trainable) 35-50%
Severe (dependent) 20-35%
Profound (life support) <20%
32. Mild mental sub normality
IQ level 50-70 %
Commonest type (80 -90%)
Good in psychomotor skills
Able to do self care and domestic skills
(eating, washing, dressing, bladder, bowel control)
Ability to use the language for everyday purposes
33. Moderate MS-Coping abilities
IQ 35-50 %
Found 10 %
Need supervision for self care (Motor skills are slow)
Learn few basic skills. unaware of needs
Epilepsy, physical and neurological disabilities are common
34. Moderate MS contd…….
Limitation of speech
Education up to grade 2
Require supervision throughout the life
Can handle small amount of money with supervision
35. Severe Mental Sub normality
Found 3-4%
Recognized early in life
IQ 20 -35%
Motor impairment
Minimal speech and communication
Poor psychomotor skills
Limited ability to perform simple task
36. Severe Mental sub normality contd…..
Motor impairment indicating mal development
of central nervous system
Self care with assistance
May learn to perform simple working
Need complete assistance and supervision
37. Profound Mental Sub normality
IQ 20 % or below
Found 1-2%
Can’t comply with request or instructions
Most of them are immobile and incontinent
Need institutional care
Little non verbal communication
Totally dependent for physical care and basic needs
38. Identify MS in early childhood
Infancy
Poor feeding
Poor weight gain
Decreased visual attention and auditory response
Delayed head and trunk control
Poor mother – child interaction
39. Identify MS in early childhood
Toddler
Delayed speech
Language disabilities
Delayed motor
milestones
Short attention span
Poor memory
Sleep problems
Emotional instability
40. contd…..
Toddler
Delayed independent sitting, crawling, pulling to stand,
and independent ambulation.
failure to develop receptive and expressive language
milestones.
41. Cont….
Almost 50% of children with mental retardation are
identified after age 3, when
speech delays manifest themselves.
42. Diagnosis of MS
History taking
Physical examination
Neurological examination
Assess developmental milestone
Investigations – EEG, CT ,Thyroid function
test
Evaluations – Hearing test ,Speech evaluation
psychological test
43. Management
An interdisciplinary team evaluation by a
developmental pediatrician, clinical psychologist,
and counselor is usually the initial step in the
management of mental retardation.
.Prevention is better than cure
44. Prevention of Sub normality
Primary prevention
Secondary prevention
Tertiary prevention
50. Secondary Prevention (Early
diagnosis and treatment)
Early detection and treatment of the
preventable disorders
Amniocentesis and medical
termination of pregnancy
Early detection of correctable disorder
Prevent them against abuse
51. Tertiary Prevention
Disability limitation
Treatment of physical and psychological
problems
Institutionalization of severe mentally retarded
or those with psychological problems
Education and training to avoid handicaps
Physiotherapy to treat the associated deficits
Rehabilitation
52. Skills training
Divide each training activity in to small steps
and demonstrate
Give repeated training in each activity
Give training regularly and systematically
Start with what child already knows
Rewards and appreciate the child
54. Skills training contd….
Use training material which are attractive,
appropriate and locally available
Try to involve with normal children in same
age
’
55. Skills training contd…
•No age limit for training
•Asses child once in
4 or 6 months
• Keep in mind ‘THEY LEARN VERY SLOWLY
57. Effects of MS on Family
Depression, guilt, shame or anger
Rejection of child
Overindulgence
Social problem
Marital disharmony
Burden of care for their child
58.
59. Nursing diagnosis
"mental sub normality" is an outdated and
potentially offensive term that is no longer used
in professional healthcare contexts. Instead,
contemporary healthcare professionals use more
respectful and clinically appropriate terminology
to describe conditions related to intellectual or
developmental disabilities.
60. Nursing Diagnosis
Risk for Injury: Patients with intellectual or
developmental disabilities may be at a higher risk
of injury due to impaired coordination, sensory
deficits, or difficulty understanding safety
instructions.
61. Impaired Communication: Many individuals with
these disabilities may have difficulty expressing
themselves or understanding verbal communication,
which can affect their ability to convey their needs
and understand medical instructions.
62. Nursing Diagnosis
Self-Care Deficit: Some patients with intellectual or
developmental disabilities may require assistance with
activities of daily living, such as bathing, dressing, or
feeding
Social Isolation: Patients with these disabilities may
experience social isolation due to communication
challenges, stigmatization, or limited social
opportunities.
63. Nursing Diagnosis
Impaired Mobility: Mobility issues, such as
difficulty walking or moving, may be present in some
individuals with developmental disabilities, which can
impact their independence and quality of life.
64. Nursing Diagnosis
Risk for Malnutrition: Patients with intellectual or
developmental disabilities may have difficulty
with feeding or making healthy dietary choices,
putting them at risk for malnutrition.
65. Nursing Diagnosis
Impaired Coping: Some individuals with these
disabilities may struggle with emotional regulation or
have difficulty coping with stress and changes in
their environment.
66. Nursing Diagnosis
Caregiver Role Strain: This diagnosis can be
relevant when family members or caregivers
experience physical or emotional strain in caring for
someone with an intellectual or developmental
disability.
67. Nursing Management
Make highly individualized, long term goals depend
on the level of retardation
Goal should be realistic
Parent involvement is essential
70. Nursing Management contd….
Maximize speech, language,
cognitive, psychomotor, social, self
care and occupational skills
Teach adaptive skills such as eating,
dressing, grooming and toileting
71. Nursing Management contd….
Ongoing evaluation for overlapping
psychiatric disorders such as
depression, bipolar disorder and ADHD
Early intervention programs for
children younger than 3years with
mental retardation
73. Nursing Management contd
Maximize speech, language, cognitive,
psychomotor, social, self care and
occupational skills
Teach adaptive skills such as eating,
dressing, grooming and toileting
74. Teach him about natural and normal
feelings and emotions
Help to learn social skills, norms and
behaviors
75. Nursing Management contd…..
Family therapy to help parents develop
coping skills and deal with guilt or
anger
Monitor the child for physical or
emotional distress
77. Nursing Management contd…..
•Prevention of exploitation and
abuse and advice for legal services
•Close collaboration with all
members of the therapeutic team
for successful outcome
79. 3. Describe causes, clinical features, diagnostic
evaluation and management of sub
normality
4. Describe classification of sub normality
5. List out preventive methods of sub
normality
6 . Describe Nursing care management for
sub normality
Summery
