1. Intellectual disability (formerly mental retardation) is a neurodevelopmental disorder characterized by below-average intellectual functioning and deficits in adaptive behaviors that arise during the developmental period. 2. It occurs in 2.5-3% of the population and has various genetic, prenatal, perinatal, and environmental/sociocultural causes. 3. Treatment involves prevention efforts, educational/psychological interventions to improve functioning, and programs to promote independence and community integration.

1. Neurodevelopmental disorder: Intellectual Disability (Mental Retardation)
By (PhD Student: Burhan Hadi and Abbas L. Muhe-Aldeen)
Introduction
Intellectual Disability (Mental Retardation) is a generalized neurodevelopmental disorder
characterized by significantly impaired intellectual and adaptive functioning.
Intellectual Disability refers to a condition in which a person's inability to learn and to
function is more limited than others of the same age.
During infancy and the toddler years, a child may be considered only a bit slow, although
delays in development and in language and motor skills may be apparent.
The essential feature of mental retardation is below-average intellectual functioning
(intelligence quotient [IQ] less than 70) accompanied by significant limitations in areas of
adaptive functioning such as communication skills, self-care, home living, social or
interpersonal skills, use of community resources, self-direction, academic skills, work, and
health and safety .
Some people with mental retardation are passive and dependent; others are aggressive and
impulsive.
Children with mild-to-moderate mental retardation usually receive treatment in their homes
and communities and make periodic visits to physicians.
Those with severe orprofound mental retardation may require day care services.
Epidemiology
 Mental retardation occurs in 2.5-3% of the general population.
 About 6-7.5 million mentally retarded individuals live in the United States alone.
 1.5 times more common among men than among women
Etiology
Genetic Factors
1. Down’s Syndrome – most common genetic cause of mental retardation
2. Fragile X Syndrome
3. Prader-Willi Syndrome
4. Phenylketonuria
5. Rett’s Disorder
Prenatal Factors
1. Fetal Alcohol Syndrome – leading single known cause of mental retardation, Prenatal
Substance Exposure
2. AIDS, Rubella, Herpes Simplex, Complications of Pregnancy (diabetes)
3. Perinatal Factors
4. Premature infants ( intracranial hemorrhages)
5. Infection
6. Meningitis and Encephalitis
7. Head Trauma
8. Brain Damage
Environmental and Sociocultural Factors
1. Low socioeconomic groups.
2. Poor prenatal and postnatal care.
3. Family instability with inadequate caretakers is common.
4. Parents with psychiatric disorders.

2. Classification
Mild
1. 50-55 to 70-85 IQ
2. 85% of MR population
3. Academic level- 6th grade
4. Holds job, makes change
Moderate
1. 35-40 to 50-55 IQ
2. 10% of MR population
3. Academic level-2nd grade
4. Makes small change
Severe
1. 20-25 to 35-40 IQ
2. 4% of MR population
3. Academic level-below 1st
4. Can use machines
Profound
1. 20-25 and below IQ
2. 1% of MR population
3. Academic level-BELOW 1st
4. Dependent on others.
Diagnostic Criteria for Intellectual Disability (Intellectual Developmental Disorder)
• The following three criteria must be met:
1. Deficits in intellectual functions, such as reasoning, problem solving, planning,
abstract thinking, judgment, academic learning.
2. Deficits in adaptive functioning that result in failure to meet developmental and
sociocultural standards for personal independence and social responsibility such as
communication, social participation, and independent living.
3. Onset of intellectual and adaptive deficits during the developmental period.
DIAGNOSIS
 History collection from parents & caretakers
 Physical examination
 Neurological examination
 Assessing milestones development
 Investigations
1. Urine & blood examination for metabolic disorders
2. Culture for cytogenic & biochemical studies
3. Amniocentesis in infant chromosomal disorders
4. chorionic villi sampling
5. 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.
 Adaptive Behavior Scales-measure of personal and social skills
 Intelligence quotient (I Q).

3. Treatment
Three major categories of intervention are essential in the treatment of mental retardation
1. First, many cases of both organic and cultural-familial mental retardation can be
prevented through adequate maternal and child health care, as well as early psych
educational programs.
2. Second, educational, psychological, and biomedical treatments can help people with
mental retardation to raise their achievement levels.
3. Third, the lives of people with mental retardation can be normalized through
mainstreaming in public schools and promoting care in the community.
 Specialized programs - in which children with mental retardation are stimulated at an
early age with appropriate sensory, motor and cognitive activities - are available in most
states.
General Nursing Intervention
1. Assess all children for signs of developmental retard.
2. Support the family at the time of initial diagnosis by actively listening to their
feelings and concerns and assessing their composite strengths.
3. Facilitate the child’s self-care abilities by encouraging the parents to enroll the child
in an early stimulation program, establishing a self-feeding program, initiating
independent toileting, and establishing an independent grooming program.
4. Promote optimal development by encouraging self-care goals and emphasize the
universal needs of children, such as play, social interaction and parental limit setting.
5. Provide child and family teaching.
Mental disorders can co-occur with ID
• psychotic conditions e.g. pica, self- injurious behaviors, MDD, ADHD, Bipolar,
Anxiety, ASD Schizophrenia
• Impulse control, Stereotypic movement disorder
• Suicide
Co-Morbid Associations
• Behavioral / Mental Illness
• Seizures
• Cerebral Palsy
• Sleep Disorders
• Recurrent Emesis
• Obesity 30-50%
• Autism 10-30%
• Hearing problem
• Heart conditions
• Visual impairment
• Constipation
Prevention
• Encourage the prevention of mental retardation
1.Encourage early and regular prenatal care.
2.Provide support for high risk infants.
3.Administer immunizations, especially rubella immunization.
4.Encourage genetic counseling when needed.
5.Teach injury prevention – both intentional and unintentional.