The document defines and classifies mental retardation according to definitions from the AAMD and DSM-IV. It notes that mental retardation involves subaverage intellectual functioning and concurrent impairments in adaptive behavior that manifest before age 18. Mental retardation is classified as mild, moderate, severe or profound based on IQ levels. The effects on families include distress, depression, rejection of the child, and dissatisfaction with medical services. Clinical features and important causes of mental retardation are also listed. The diagnosis and management of mental retardation are discussed.

1. CHILD
PSYCHIATRY

2. DEFINITION MENTAL RETARDATION.
AAMD and DSM-1V defines mental retardation as significantly sub
average general intellectual functioning resulting in or associated with
concurrent impairment in adaptive behavior and manifest during the
developmental period –that is before the age of 18Definition

3. CLASSIFICATION
 Mild mental retardation IQ level 50-55 to approx 70.
 Moderate retardation IQ level 35-40 to 50-55.
 Severe mental retardation IQ level 20-25 to 35-40.
 Profound mental retardation IQ level below 20-25.
 Mental retardation severity unspecified: when there is a
strong presumption of mental retardation but the person’s
intelligence is untestable by standard test.

4. EFFECTS OF MENTAL RETARDATION ON FAMILY
 Distress and feeling of rejection
 Depression guilt shame or anger
 Rejection of child
 Overindulgence
 Social problems
 Marital disharmony
 Burden of care for their child
 Dissatisfaction among medical and social services

5. CLINICAL PICTURE OF MENTALLY RETARDED:
 Mouth –small mouth and teeth, furrowed tongue, high arched
palate.
 Eyes-oblique palpebral fissures, epicanthic folds.
 Head –flat occiput
 Hands –short and broad, curved fifth finger ,single transverse
crease
 Joints –hyper extensibility or hyper flexibility,hypotonia poor
Moro reflex
 Others –CHD especially ASD,VSD PDA and arterioventricalar
communes in about 40% cases
 Burchfield spots (whitish spacklings on the iris)
 Flat facieses
 Small dysplastic ear
 Impaired hearing and intestinal abnormalities(specially
duodenal obstruction)
 Hypothyroidism
 Epilepsy
 Ocular disturbances

6. IMPORTANT CAUSES OF MENTAL
RETARDATION:
 Prenatal causes:
 Intranatal causes:
 Postnatal damage:
 Genetic
Chromosomal abnormalities:
Metabolic disorders affecting
Gross disease of brain
Cranial malformation
Sociocultural causes
Psychiatric condition

7. DIAGNOSIS OF MENTAL
RETARDATION:
 History
 General physical examination
 Detailed neurological examination
 Mental status examination

8. MANAGEMENT OF MENTAL
RETARDATION:
 Primary prevention:
 Secondary prevention (early diagnosis and
treatment)
 Tertiary prevention:

9. SPECIFIC DEVELOPMENTAL
DISORDERS
Reading
Language
Arithmetic or
mathematics
Articulation
Co-ordination

10. DEVELOPMENTAL LANGUAGE
DISORDER
Expressive language
disorder
Mixed receptive-
expressive language
disorder

11. ETIOLOGY
Acquired type-due to
demonstrable neurologic
disorder or head trauma
Developmental type
which has no known
cause

12. CLINICAL FEATURES
 The essential feature of Expressive language
disorder is a specific deficit in the development of
Expressive language abilities. Nonverbal
intelligence and receptive language development
are not affected.

13. MIXED RECEPTIVE
 Etiology
 Genetic Tendency
 Left hemispheric dysfunction
 Socio economic factors like large family, lower
social class, late birth order and environmental
deprivation

14.  Clinical features-developmental type
 Vocabulary comprehension difficulties occur with
prepositions, adjectives, adverbs and pronouns
 Grammatical comprehension deficits occur with
misinterpretation of grammatical units or
morphemes(such as noun plurals, verb. tenses etc)
 Pragmatic comprehension deficits are manifested by
abnormalities with conversational skills such as turn
taking, maintaining a topic and being polite. There is also
a delay in speech-language mile stones(babbling, saying
the I word, the I sentences etc)

15. Acquired type-the effects of
cerebral trauma vary in
severity, locus and extent.
Right hemisphere damage is
predictive of comprehension
impairment, unilateral left
hemisphere lesion results in
expressive or phonological
problems

16. DEVELOPMENTAL READING
DISORDERS
 Etiology
 Unknown
 Prenatal /postnatal factors such as prematurity, low
birth weight, toxemia of
pregnancy, hyperbilirubinemia, recurrent
otitis, meningitis, encephalitis and anemia.

17.  Clinical features
 Inaccurate reading, slow reading and poor reading
comprehension
 Word recognition is poor
 The misreading may be distortions, substitutions or
omissions of words
 Course
 Recognition is at 5 yrs of age. The disorder tends to
improve overtime with or without treatment but it is very
slow and never complete.

18.  Treatment
 Remedial education-direct instruction in reading ,practice
with letter sound associations, word recognition tasks
and reading comprehension
 Medical approaches include stimulants,anti-anxiety drugs
and special diets
 Psychosocial approaches are supportive
psychotherapy, parent guidance and training, social skills
training, relaxation therapy and behavior modification
approaches.

19. DEVELOPMENTAL ARITHMETIC
DISORDER
 It is impairment in the development of arithmetical
or mathematical skills that is sufficiently serious to
interfere with academic achievement of daily living.
The impairment cannot be explained by the
persons measured intelligence levels, educational
background, visual acquity.
 Etiology –is unknown

20.  Clinical features
 Symptoms include difficulties in performing basic
arithmetical operations, memorizing numerical
facts, following sequences of mathematical
steps, counting objects and multiplying.
 Attention symptoms include inaccurate copying of
numbers, omitting digits, decimals or symbols when
writing answers, forgetting to add in carried numbers
during addition and addition and filing to note arithmetical
signs.
 Course
 Mathematical difficulties’ may be apparent in the
kindergarten stage but a diagnosis can be made only
when the child comes to the 2nd or 3rd grade.

21.  Treatment
 Various options are special classroom placement,
supplemental remedial tutoring, perceptual skills training
(focusing on skills such as matching, sorting and
arranging objects) diagnostic –prescriptive teaching (i.e.
focusing on actual mathematics deficits) and cognitive –
developmental teaching (i.e. where the teacher facilitates
learning through areas of cognitive strength in the child.

22. ARTICULATION DISORDER
(PHONOLOGICAL DISORDER)
 Etiology
 Causes can be hearing impairment, structural
deficits of the oral peripheral speech mechanism
(cleft palate), neurological disorders (cerebral
palsy) cognitive limitations (M.R) and psychosocial
deprivation

23. DIAGNOSIS AND CLINICAL FEATURES
 Speech sound disorders are characterized by
omissions, substitutions and distortions of speech
sounds. In phonological disorder, the speech
sounds that are most frequently misarticulated are
those that tend to be acquired last in the normal
language acquisition process (e.g. sounds
represented by the letters S, Z, sh, ch, dg, th, dz
and r)

24. TREATMENT
1. A child needs speech therapy if
 Speech intelligibility is poor
 The child is older than 8 years
 The articulation problem is apparently contributing to or causing
problems with peers self image or learning.
 The articulation impairment is severe
2. In addition, peer relationships, school behaviors and learning
process also has to be monitored

25. DEVELOPMENTAL CO-ORDINATION
DISORDERS (OR) DISORDER OF WRITTEN
EXPRESSION:
 Diagnosis and clinical features:
 Treatment:

26. PERVASIVE DEVELOPMENTAL
DISORDER:
 Autistic disorder:
 Etiology:
Genetic
Neurological
Metabolic
Immunologic
Environmental factors
Complications from birth
Abnormality in the structure and functioning of the
brain.

27.  EPIDEMIOLOGY:
 Clinical description:
 Behavioral symptoms such as:
 Hyperactivity
 Short attention span
 Impulsivity
 Aggressivity
 Self injurious behavior
 Temper tantrum
 Abnormal eating patterns

28.  Abnormal sleeping patterns
 Repeatitive, restricted, stereotypic patterns of behavior
 Do not actively indulge in normal play
 Fascinated with revolving objects like revolving
fans,opening and clocing the door ,constantly turning the
light on and off.
 Approximately 8o% of individuals with autistic disorder
have some degree of mental retardation,50% have
severe or profound and 30% have mild mental
retardation
 Affects the cognitive areas such as judgment, insight and
reasoning
 Communication problems and both verbal and non verbal
areas are affected

29.  Prognosis:
 There is no cure for autism evidence demonstrate that
early intense educational interventions using highly
structured progrrammes helps the clients to achieve the
highest level of functioning in social, communication and
cognitive skills.

30. ASPERGER’S DISSORDER:
 RETT’S DISORDER:
 CHILDHOOD DISINTEGRATIVE DISORDER:

31. ATTENTION DEFICIT AND DISRUPTIVE
BEHAVIOUR DISORDER:
 Attention deficit hyperactivity disorder:
 It is a disorder characterized by
inattentiveness, over activity and impulsiveness .it
is a common disorder especially in boys and
probably accounts for more referrals of childhood
disorder than any other disorder (Hetchman, 2005)

32. ONSET AND CLINICAL COURSE:
ETIOLOGY:
Environmental toxins
Prenatal influences
Hereditary
Damage to brain structure and function
Prenatal exposure to alcohol ,tobacco and
lead
Severe malnutrition
Decreased metabolism in the frontal lobe
Decreased blood perfusion to the frontal
cortex

33. TREATMENT:

34. CONDUCT DISORDER:
 It is characterized by persistent antisocial behavior
in children and adolescents that significantly
impairs their ability to function in social, academic
or occupational areas.

35. SYMPTOMS:
 Symptoms are clustered in four main areas:
 Aggression to people and animals.
 Destruction of property
 Deceitfulness and theft
 Serious violation of rules

36.  ONSET AND CLINICAL COURSE:
 CLASSIFICATON OF CONDUCT DISORDER:
 MILD: some conduct problems relatively minor
harms
 MODERATE: number of conduct problems
increases as the harm to others also
 SEVERE: person has many conduct problems and
considerable harm to others

37. ETIOLOGY:
 Genetic vulnerability
 environmental adversity
 poor parenting
 low academic achievement
 poor peer relationship
 low self esteem
 resilience
 poor family functioning
 marital discord
 family history of substance abuse

38. TREATMENT:
 Parenting education
 Social skill training
 Improving peer relationship
 Attempts to improve academic performance
 Family therapy
 Individual therapy
 Conflict resolution
 Anger management
 Teaching social skills
 Antipsychotic medication with therapy if the patient
is very violent

39. OPPOSITIONAL DEFIANT DISORDERS:
 This disorder consists of an enduring pattern of
uncooperative, defiant and hostile behavior towards
authority figures without major antisocial violation.
 It can only be diagnosed when the behavior is
intense and more frequent found in about 5% o0f
population and equal in both the males and females
causes dysfunction in social, academic and work
situation and 25% of them develop conduct
disorder and the treatment is as same as conduct
disorder.

40. FEEDING AND EATING DISORDER:
 The disorder of feeding and eating included in this
category are persistent in nature and not explained
by underlying medical condition:
 PICA:
 RUMINATION DISORDER:
 FEEDING DISORDER:

41. TIC DISORDER:
 A tic is a
sudden, rapid, recurrent, nonrhythmic, stereotyped
motor movement or vocalization. Tics can be
suppressed but not indefinitely a stress exarbates
tic which diminishes during sleep and when the
person is engaged in an absorbing activity.
 TOURETT’ S DISORDER:
 CHRONIC MOTOR OR TIC DISORDER:

42. ELIMINATION DISORDER:
 ENURESIS AND ENCOPRESIS

43. ENURESIS
 Definition: Enuresis is defined as the repeated
voiding of urine into clothes or bed, whether the
voiding is involuntary or intentional. The child’s
chronological or developmental age must be at
least 5 years. (DSM IV).

44.  Types:
 Based on the Onset:
 Primary enuresis:
 Secondary enuresis:
 Based on the time:
 Nocturnal enuresis:
 Diurnal enuresis:
 Both diurnal and nocturnal
 When it occurs both the times primary and nocturnal
types of enuresis are more common than the others.

45. ETIOLOGY
 Genetic factor
 Disorder of genitourinary tractAssociation with UTI
 Urinary tract obstruction
 Bladder size and functions
 Developmental changes in the bladder neck
 Urinary circadian rhythm
 Disorders of CNS
 Depth of sleep
 Epilepsy and EEG abnormalities
 Neuroleptic-induced enuresis-for e.g. thiothixene and
thioridazine.incontinence with phenothiazine induced catatonic
states and stress incontinence in patients receiving
chlorpromazine
 Developmental delays
 Enuresis is a disorder arising from disturbances in early life.

46.  i) Toilet training
 ii) Stressful life events in early childhood
 Diagnosis
 Criteria for non-organic enuresis
 The child’s chronological and mental age is at least 5
years
 Involuntary or intentional aged under 7 years and at least
once a month in children aged 7 years or more
 The enuresis is not a consequence of epileptic attack or
of neurological incontinence and are not a direct
consequence of structural abnormalities of the UT or any
other psychiatric condition
 There is no evidence of any other psychiatric disorders
that meets the criteria for other ICD-10 categories
 Duration of the disorder is at least 3 months

47.  COURSE AND PROGNOSIS
 TREATMENT
 1. Behavioral interventions
 2. Retention control training ( RCT)
 3. Dry bed training
 Drug treatment
 Psychotherapy

48. ENCOPRESIS:
 Types
 1. Primary type-where toilet training has never been
achieved
 2. Secondary type-where Encopresis emerges
often a period of fecal continence. This type
typically occurs between the ages of 4 &8

49.  Etiology
 Inadequate, inconsistent toilet training
 Ineffective and inefficient sphincter control
 Neuro developmental problems-easy distractibility ,short
attention, span, low frustration tolerance, hyperactivity etc
 Fear of toilet
 Emotional reasons-fear, anxiety, anger etc
 Sibling rivalry
 Maturational lag
 Mental retardation
 Childhood schizophrenia
 Autistic disorder

50. DIAGNOSIS

51. CLASSIFICATION :
 Classification
 Treatment.