The document discusses intellectual disability (previously termed mental retardation), defining it as significantly sub-average intellectual functioning and adaptive behavior deficits beginning before age 18, affecting 2-3% of the population. It highlights causes, types of intellectual disabilities ranging from mild to profound, associated comorbid conditions, and the management of the condition through educational support, behavioral interventions, vocational training, family education, and psychopharmacologic treatments. The text also emphasizes the importance of a multidisciplinary approach for diagnosis and tailored treatment to enhance the quality of life for individuals with intellectual disabilities.

1. MENTAL RETARDATION
(Intellectual
disability)
MS. LAMLYNTI LANGBANG
ASSISTANT PROFESSOR
DEPARTMENT OF PSYCHIATRIC
NURSING

2. INTRODUCTION
The term "mental retardation" has been largely replaced in the medical and
psychiatric communities with "intellectual disability" (ID) or "intellectual
developmental disorder." .
The term "intellectual disability" focuses on limitations in intellectual functioning
and practical skills, such as problem-solving, social understanding, and self-care.
Children with intellectual disabilities typically have an intelligence quotient (IQ)
below 70 and deficits in at least two adaptive behaviors that affect everyday living.
According to the DSM-5, intellectual functions include reasoning, problem
solving, planning, abstract thinking, judgment, academic learning, and learning
from experience

3. ICD-10 defined Mental Retardation as a condition of arrested or
incomplete development of the mind, which is specially characterized
by the impairment of skills manifested during development period
that contribute to cognitive(knowledge), language, motor and social
abilities.
Mental retardation (MR) is a disorder characterized by significantly
sub-average general intellectual function and IQ of 70 or below, with
impairment in adaptive behaviour (including thinking, learning, social
and occupational adjustment) and manifested during the development
period (below 18).

4. EPIDEMIOLOGY
Frequency
 Intellectual disability affects about 2–3% of the general
population. Seventy-five to ninety percent of the
affected people have mild intellectual disability.
 However, more than 20 million people are mentally
retarded in India. About three of every 100 people belong
to this category and one of these will not be able to take
care of themself. So, they become totally dependent on
others, while others will be partially handicapped.
Incidence
 Incidence of MR seems to increase sharply at the age of
five with the number of cases identified at the age of 15
years.

5. ETIOLOGY/ RISK FACTORS
 Genetic Factors: Genetic syndromes such as Down syndrome, Fragile X syndrome, and
Williams syndrome are common causes. In some cases, single-gene disorders or
chromosomal abnormalities are involved.

6.  Prenatal period : lack of adequate nutritional diet to mother, viral infection in the first trimester (3
months) of pregnancy such as pertussis, mumps rubella infection, Rh incompatibility and premature
birth.
Lack of adequate food

7.  Natal : During birth-trauma, mechanical injury to the child’s brain while helping in delivery. Asphyxia,
difficult labour, anoxia leading to MR, 20-30 % of feeble-mindedness occur due to mismanaged
childbirth.
Birth trauma/mechanical injury

8.  Postnatal: Infections (such as encephalitis, meningitis) malnutrition, and traumatic brain injury
in early childhood are significant postnatal risk factors

9.  Disorders of Metabolism. Phenylketonuria,
hypothyroidism.
 Intoxication: Bilirubin encephalopathy, lead
poisoning and post-vaccinal encephalitis
 Untreated Epileptic Fits

10.  Psychosocial Factors: Socioeconomic status, parental education level, and availability of
early intervention services can also influence developmental outcomes.

12. Mild Mental Retardation/Mild Intellectual
Disability
 IQ Range: Approximately 50-70
 Characteristics:
• Individuals with mild intellectual disability often develop social and communication
skills during their early childhood, though they may experience delays.
• In an educational setting, they can learn basic academic skills, though at a slower
pace than their peers. Many reach about a 6th-grade academic level by adolescence
or early adulthood.
• With appropriate support, they can acquire vocational skills and engage in jobs that
do not require complex tasks. These individuals can often achieve a degree of
independence and may live semi-independently or fully independently with minimal
support.
• Social and Emotional Functioning: While they may face challenges in complex
social situations, many individuals with mild ID develop relationships and social
connections. They may need occasional help in decision-making and planning.

13.  Support Needs:
• Educational support, vocational training, and community
programs can enhance their independence and ability to
perform in the workforce.
• Social skills training and adaptive behavior interventions
help them navigate social situations more effectively.
• Many benefit from transitional support services as they
move from school to work environments.

15. Moderate Mental Retardation/Moderate
Intellectual Disability
 IQ Range: Approximately 35-49
 Characteristics:
• Individuals with moderate intellectual disability exhibit more pronounced
developmental delays and often require support for day-to-day functioning.
• Communication skills may be basic, and academic achievement typically does not
go beyond the 2nd-grade level, even with specialized education.
• They may learn some reading, writing, and basic math but usually struggle with
abstract concepts. While they might perform well in routine tasks, adapting to new
tasks or unfamiliar situations can be challenging.
• Social and Emotional Functioning: Many have limited social judgment and
experience difficulties in complex social interactions. With guidance, they can
develop relationships but may need ongoing help to manage social and emotional
challenges.

16.  Support Needs:
• Moderate intellectual disability often requires structured support
for work, personal care, and independent living. These individuals
may live in group homes or supported living arrangements.
• Vocational training programs are usually focused on helping them
learn practical skills for supervised employment in structured
environments.
• Behavioral interventions and life skills training can be very
beneficial in helping them gain and maintain independence to the
fullest extent possible.

17. Training modules
and vocational
training for
Moderate Mental
Retardation

18. Severe Mental Retardation/Severe
Intellectual Disability
 IQ Range: Approximately 20-34
 Characteristics:
• Severe intellectual disability often entails significant limitations in
communication, mobility, and daily functioning.
• Verbal communication skills are typically limited, and many individuals use
nonverbal forms of communication or alternative communication devices.
• They require close supervision and assistance with personal care, such as
dressing, bathing, and meal preparation. Basic skills like recognizing familiar
people or following simple commands are usually achievable, but more complex
skills are often beyond reach.
• Social and Emotional Functioning: Severe ID significantly limits social
abilities, though individuals may show attachments to familiar people and enjoy
simple social interactions. Social understanding is often minimal, and they may
rely on caregivers for assistance with interpreting and responding to social cues.

19.  Support Needs:
• Individuals with severe ID usually need continuous support
throughout their lives, particularly in daily living and social
activities.
• They often benefit from sensory-focused and structured
environments to reduce stress and provide predictable
routines.
• Adaptive equipment, communication aids, and behavioral
therapy may improve their ability to engage with their
environment and develop functional skills.
• They are often placed in specialized residential settings where
they can receive full-time care and assistance.

21. Profound Mental Retardation/Profound
Intellectual Disability
 IQ Range: Below 20
 Characteristics:
• Individuals with profound intellectual disability have severe limitations in all aspects
of intellectual and adaptive functioning.
• They may have multiple physical disabilities, such as difficulties with mobility, vision,
or hearing impairments, and require full assistance for all activities of daily living.
• Communication is typically nonverbal, often limited to basic responses or gestures.
They may only be able to understand and react to familiar faces and highly
structured environments.
• Social and Emotional Functioning: Social interactions are extremely limited, though
many individuals can still form attachments with caregivers. They often display
reactions to sensory experiences, such as touch or familiar voices, but
understanding of social relationships is very basic.

22.  Support Needs:
• Profound intellectual disability requires comprehensive, life-
long support, typically in a fully assisted living environment
such as a specialized care facility.
• Support often includes medical care, physical therapy,
occupational therapy, and specialized communication aids
designed to support basic engagement and comfort.
• Because individuals with profound ID may have complex
medical needs, they often require routine monitoring, medical
interventions, and personalized care plans to maintain their
health and comfort.

23. Profound Mental
Retardation /
Profound Intellectual
Disability children

24. Associated Psychiatric and Behavioral
Conditions
Individuals with Mental Retardation/Intellectual Disability are at higher risk for co-
occurring psychiatric and behavioral conditions, which can complicate diagnosis and
treatment. These conditions may include:
 Attention-Deficit/Hyperactivity Disorder (ADHD): Higher prevalence among those
with mild to moderate intellectual disability.
 Autism Spectrum Disorder (ASD): Intellectual disability and autism frequently co-
occur, particularly among those with more severe forms of both conditions.
 Anxiety and Depression: Higher rates are seen, possibly due to social isolation,
bullying, and reduced coping mechanisms.
 Aggression and Self-Injurious Behavior: Some individuals may develop
maladaptive behaviors, including self-harm and aggression toward others, especially
when they have difficulty communicating needs or frustrations.
 Impulse Control Disorders: Often, challenges with self-regulation contribute to
impulsive behaviors, including repetitive or ritualistic actions.

25. Assessment and Diagnostic Tools for
Mental Retardation/Intellectual Disability
Diagnosing mental retardation/intellectual disability often involves a multidisciplinary
team, including psychologists, psychiatrists, and social workers, who may use:
• Standardized IQ Tests: Wechsler Intelligence Scale for Children (WISC) and
Stanford-Binet are commonly used tests for measuring intellectual functioning.
• Adaptive Behavior Scales: Tools such as the Vineland Adaptive Behavior Scales
(VABS) and the Adaptive Behavior Assessment System (ABAS) assess practical,
social, and conceptual skills.
• Medical and Genetic Testing: To rule out genetic syndromes or underlying
medical conditions.
• Behavioral and Psychiatric Assessments: Particularly important in cases where
comorbid mental health conditions are suspected.(e.g Mental Status Examination)

26. DSM-5 Criteria for Mental Retardation/ Intellectual
Disability
1. Deficits in Intellectual Functioning:
This includes reasoning, problem-solving, planning, abstract thinking, judgment,
academic learning, and experiential learning, confirmed by both clinical assessment and
standardized intelligence testing. Typically, an IQ score around 70 or below is used as a
guideline but is not the sole determining factor.
2. Deficits in Adaptive Functioning:
These are impairments in adaptive behaviors that impact the individual’s ability to meet
age-appropriate standards in personal independence and social responsibility. This
must be evident in at least one of the following domains:
•Conceptual (e.g., academic skills, memory, language)
•Social (e.g., communication, interpersonal skills)
•Practical (e.g., personal care, occupational skills)
These deficits should limit functioning across multiple settings, such as home, school,
work, or the community.
3. Onset During the Developmental Period:
Symptoms must begin during the developmental period (typically before the age of 18).

27. Treatment and management of Mental
Retardation/Intellectual Disability
Management of intellectual disability must begin promptly with the goals of preventing further
worsening, minimizing the symptoms of disability, and improving the quality of everyday life. When
initiating therapy, a healthcare provider must be aware of the various avenues of treating intellectual
disability to orchestrate a multidisciplinary and individually tailored treatment appropriately.
1. Educational support: It is a crucial component of intellectual disability management. Upon
diagnosis of intellectual disability in children, healthcare providers must contact the school
promptly to set up special education arrangements. What special education entails may vary
slightly among schools, but it typically aids comprehensively with providing academic
modifications as well as transition planning from childhood to adulthood with a focus on
promoting self-sufficiency. It also teaches them how to seek assistance, behavioral skills,
vocational skills, communication skills, functional living skills, and social skills based on
individual needs in the least restrictive environment. Creating the least restrictive environment
for students with an intellectual disability means placing them in general classrooms as much as
tolerated. Monitoring the patients' progress in school is important because education solely from
classroom settings may not be sufficient. If an individual with an intellectual disability requires
assistance beyond what is available at school, the family can meet the need at home through
family education or other outside resources.

28. 2. Behavioral intervention: It is another important aspect of intellectual disability
management, and it can occur in a few different ways. Behavioral therapy aims to
encourage positive behaviors while discouraging undesirable behaviors. Providing
positive reinforcement and benign punishments (e.g., time-outs) is an effective method
of behavioral training. Other supplemental methods may include avoiding triggers of
negative demeanor, shunning misconduct, and redirecting to prevent or curtail any
troublesome behavior. Cognitive therapy is another mode of behavioral training that has
been effective for eligible intellectual disability patients. Cognitive therapy has its basis
on the principle that one's behavior, emotions, and cognitions are connected, and it
aims to correct one's negative behaviors by identifying and adjusting negative thoughts
and emotional stress. Although many other approaches to behavioral intervention exist,
the implementation of behavioral therapy, cognitive therapy, or a combination of the two
is the most widely used method that has been shown to be an effective means of
behavioral intervention for intellectual disability patients.
3. Vocational training :It helps teenagers and young adults to obtain the necessary
skills to enter the labor market. In vocational training, patients carry out pre-scheduled
activities under the supervision of an interprofessional team consisting of a social
worker, occupational therapist, teacher, counselor, and psychologist. Patients learn to
keep themselves clean, wear appropriate clothes, and carry out their responsibilities. A
study has shown that patients who underwent vocational training had reduced support
requirements compared to their peers.

29. 4. Family education: It is an essential service provided by healthcare providers for
family members of intellectually disabled patients. The first part is assisting the family
members in understanding intellectual disability: definition, management, and
prognosis. Then, healthcare providers can help the family through placement decisions,
refer them to appropriate services and equipment, and provide caregiver training. In
addition to preparing the family for the patient, physicians must recognize that family
members also often bear a significant amount of stress. The medical team must support
the whole family through psychosocial problems such as the need for respect, feeling
helpless, depression, and anxiety. There are also outside resources to which the family
can obtain a referral. American Association on Intellectual and Developmental
Disabilities (AAIDD), The Arc of the United States, and Family-to-family Health
Information and Education Centers are some of the nationally available resources, and
social workers can help connect the families with local resources. Establishing strong
support for the family, in turn, creates a caring home environment for the patient.

30. 5. Psychopharmacologic interventions: It may not be the main component of intellectual disability
treatment, but they play a significant role in treating behavioral abnormalities associated with
intellectual disorders and comorbid conditions. Aggressive behavior is not uncommon among
individuals with intellectual disabilities and causes admission to institutional settings.
Risperidone is well-documented to treat disruptive, aggressive, and self-injurious behaviors in
children with intellectual disabilities with good safety and tolerability profiles. Aripiprazole is
another atypical antipsychotic that is used to manage aggression.
Treatment of comorbid conditions is an important aspect of adequate therapy.
Attention-deficit/hyperactivity disorder (ADHD), depression, and movement disorders are some of
the comorbid conditions accompanying intellectual disability that require evaluation and
treatment. Methylphenidate, clonidine, and atomoxetine are shown in randomized control trials to
reduce ADHD symptoms.
Depressive symptoms can be easily overlooked in individuals with intellectual disabilities when
other behavioral problems are prominent; this requires careful evaluation. Selective serotonin
reuptake inhibitors (SSRIs) such as fluoxetine, paroxetine, and sertraline were shown in multiple
studies to help with depressive symptoms in this patient population.
Involuntary movements, repetitive self-stimulatory behaviors, and obsessive-compulsive
symptoms may be harmful to the patients. Antipsychotic medications have been anecdotally
reported to diminish these symptoms, although there was no observation of improvement in
adaptive behavior. SSRIs are useful in treating obsessive-compulsive symptoms and stereotyped
motor movements.

31. Complication of Mental Retardation/
Intellectual Disability
Most individuals with intellectual disabilities have comorbid psychiatric
conditions. Individuals are at higher risk of developing depression because
they are prone to developing negative self-images as they have difficulty
interacting with others and meeting social expectations. Other psychiatric
comorbid symptoms frequently observed in these individuals are
hyperactivity, self-injurious behaviors, and repetitive stereotypical behaviors

32. THANK YOU