This document provides information on mental retardation (MR), including its definition, prevalence, grades, signs and symptoms, developmental assessment tests, and management approach. MR affects about 1-3% of the population and is characterized by below-average intellectual functioning and adaptive deficits. It is diagnosed based on clinical features and assessment of intellectual functioning using IQ tests. Management focuses on identifying treatable causes, providing early intervention, education/training, and supporting independent living.

1. DR.SANDIP GUPTA
PGT,PEDIATRICS
B.S.M.C.H.

2. INTRODUCTION
• Mental retardation is one of most common
chronic neurologic disabiity of childhood.
• MR affects about 1-3% of population.
• Majority of cases are idiopathic.
• Most common mild MR(75-90%) often goes
unrecognised.
• More common in lower socio-economic
groups.

3. DSM IV – TR Definition
 Significantly below average intellectual functioning:
IQ of below 70 on an individually administered IQ
test.
 Accompanied by significant limitations in adaptive
functioning in at least 2 skill areas:
Communication, self-care, home living,
social/interpersonal skills, use of community
resources, self-direction, functional academic
skills, work & leisure, health and safety.
 Onset before age 18yr.

5. Signs & Symptoms
• Delay in language development.
• Find it hard to remember things.
• Difficulty in learning social rules.
• Have trouble learn specific subject
• Have trouble solving problems
• Lack of social inhibitors.
• Lack of self care skills.
• Persistence of infantile behaviour .
• Unable to take higher education.

6. Grades of MR :
According to IQ :
• Borderline intellectual functioning70--84
• Mild mental retardation 50–69
• Moderate mental retardation 35–49
• Severe mental retardation 20–34
• Profound mental retardation Below 20

7. Mild MR
• May not be obvious in early childhood, untill they go
to school.
• In School - have poor academic performance
(difficult to differentiate from learning disability or
emotional & behavioral disorder.)
• can learn reading & mathematical skills to level of a
typical 9-12 yr child.
• Learn self care &practical skills to live independently
& earn for them self.

8. Moderate MR
• obvious within 1st year of life
• Problem with social work
• Behaviourable age -8 yrs
• Academic skills – 2nd grade level
• will face difficulty in school, at home, and in the
community
• Need special school, but they can still progress to
become functioning members of society. As adults
they may live with their parents, in a supportive
group home.

9. Severe & Profound MR
• Little or no speech
• Limited abilities to manage self care.
• Require high supervision .
• Behaviourable age – 3 yrs.
• They may learn some daily activities but will
require full time care –taker.

10. ASSOCIATED PROBLEMS
• Self injury
• Pica
• CP
• Epilepsy
• Toilet probs
• Sleep disorders
• Eating problems
• Poisoning
• Sexual abuse
• Learning disorders
• Behavior problems

11. Developmental assesment
• Denver Development Screening Test-II
• Bayley Scales of Infant Development
• BARODA PHATAK DST
• Trivendrum Developmental Screening Chart
Test for intelligence
• Binet kamat test
• Weschler’s intelligence scale for children
• Goodenough draw a man test.

12. Denver II Developmental Screening Test
• Most widely used test for quick routine
screening, for children upto 6yrs.
Assesses child development in all four domains
(gross motor , fine motor adaptive, language,
personal social behavior),taking 10-30 min.
• The milestones are shown in a graphical
manner & items through which the
chronological age passes are tested.

15. BAYLEY SCALE OF INFANT DEVELOPMENT
• Based on motor scale , mental scale and infant behaviour
• Up to 30 months of age
• Takes 30-60 minutes
• 67 motor scale ,107 mental scales
BARODA DEVELOPMENT SCREENING TEST
• Based on BSID, developed by Dr. phatak according to
baroda norms, suitable for Indian children.
• Does not require standard equipment, domains
evaluated are gross motor ,fine motor, cognitive, takes 10
min.

18. Wechsler Intelligence Scale for children
• for children from 5-15yrs
– Mean score of 100 with standard deviation of 15
– Gives verbal and performance scores, takes 45-60 min.
– Broken into 12 subtests 6 each for verbal & performance abilities.
• MALIN INTELLIGENCE SCALE FOR INDIAN CHILDREN:
- Indian adaptation of WISC
- It may not give real capabilities in non school going children as mostly
influenced by formal schooling system

19. STANFORD BINET INTELLIGENCE SCALE
• for children>2yr.
• Include verbal ability ,perceptual skills , short
term memory & hand and eye co-ordination
• takes 45-60 minutes
• BINET – KAMAT TEST
-indian adaptation of stanford - binet scale
- also available in hindi

20. Goodenough harris
‘draw a man test’

21. APPROACH TO A CHILD WITH MR
• Detailed development history.
• Antenatal history.
• Perinatal history.
• Any neurological problem: seizure, spasticity,
motor deficit, abnormal movements, vision&
hearing.
• Features s/o of IEM: abdominal distension.
• F/o of hypothyroidism.
• Past history of febrile encephalopathy.

22. Cont..
• Emotional deprivation.
• Level of indipendence.
• Scholastic performance.
• Consangiunity.
• Sibling history.
• H/o temper tantrums, hyperkinesis, self
destructive behaviour.
• Any h/o physical & psychological abuse.
• Lead exposure.

23. Physical examination
• Anthropometry : OFC, shape, frontanelle
sutures, monitor OFC.
• Dysmorphic features: f/o MPS,f/o down’s
syndrome, fragileXsyndrome,
• Neurocutaneous disorder.
• Detailed neurological examiation: tone,
power, primitive reflexes, symmetry.
• Assesment of hearing & vision.

24. Investigations
• Individualised approach
• Vision & hearing assesment
• R/o hypothyroidism.
• Cytogenetic study: high resolution g banding karyogram
screening for numeric& structural anomalies,
• FISH analysis for subtelomeric rearrangement.
• Neuroimaging: MRI & CT scan.
• IEM EVAUATION:24 hr urinary screening for aminoacids,
organic acids, GAGs, pl.aminoacids, Enzymatic study in
fibroblasts & lymphoblasts.
• EEG
• Xray
• Fragile X syndrome screening

25. Management
Treatable /Preventable causes of MR
• Hypothyroidism
• Severe PEM
• Perinatal asphyxia
• Preterm /LBW
• Meningitis, encephalitis
• Bilirubin encephalopathy
• IEM: Galactosemia ,PKU

26. Prevention
• Primary prevention: improvement in perinatal
care, iodistion of salt,immunisations,detection
&care of high risk pregnancies, penatal screening
&genetic counselling.
• 2nd ary prevention: neonatal screening, screening
of “high risk babies” & early intervention
measures.
• Tertiary prevention: stimulation, training,&
education, vocational oppertunities.
• Mainstreaming
• Support for families
• Parenteral support groups.

27. Drug Therapies
• No specific drugs but some symptoms can be
controlled.
• Neuroleptic drugs to reduce aggressive and
antisocial behavior (phenothiazines).
• antipsychotic drugs( risperidone).
• Antidepressant drugs can improve sleep, possibly
help reduce self-injurious behavior, reduce
depression.

28. TAKE HOME MASSAGE
• Mental retardation is preventable in some cases.
• Most cases are idiopathic & are mild.
• Diagnosis is clinical.
• Examination for dysmorphology & detailed
neurology is of essence.
• Care rather than cure is the way of management in
most of the cases.

31. GROSS MOTOR: 180 degree flip
examination in infant < 8 months and gait
for > 1 year
• Supine: Note posture, abnormal ATNR, involuntary
movements with CP. paucity of movements for hemiplegia.
• Pull to sit: head lag. Sitting: Head and trunk control. Back is
straight or rounded.
• Weight bearing: scissoring, hypotonia, advanced weight
bearing (CP)
• Ventral suspension: Describe posture, low tone, increase
extensor tone.
• Prone: Observe ability to raise head, trunk above horizontal,

32. Primitive reflexes:
1. Sucking/Rooting :( 0-4,6mths),
2. Palmer grasp; (0-3 months).
3. Placing, stepping: (0-6weeks)
4. ATNR: 2-6 Months.
5. Landau: on ventral suspension, normally extend head, trunk,
and hip. Flex head and neck, response is flexion of hip, trunk.0-6
month).
6. Neck righting reflex: rotation of trunk 6mths-2 years.
7. Moro: 0-4 months.
8. Parachute: 6-12 months persist. Prone position, move rapidly,
face down. Will extend both upper limbs.