Mental Retardation & Care of Child with Mental Retardation

4. MENTAL RETARDATION,
CARE & REHABILITATION OF
MENTALLY RETARDED CHILD
PRESENTED BY:
MRS. KAVITA MITHE
CLINICAL INSTRUCTOR
P. D. H. CON

5. INTELLECTUALDISABILITY

6. DEFINITION OF MENTAL
RETARDATION
 MENTAL RETARDATION refers to significantly sub-average general intellectual
functioning resulting in or associated with concurrent impairments in adaptive
behaviour and manifested during the developmental period. (American Association on
Mental Deficiency,1983).

7. General intellectual
functioning is defined as the
result obtained by
administration of standardized
general intelligence tests
developed for purpose &
adopted for the conditions of
country.
Significant subaverage
functioning is defined as
IQ of 70 or below on
standardized measures of
intelligence.
Adaptive behaviour is
defined as the degrees with
which the individual meets
the standards of personal
independence & social
responsibility expected of
his age & cultural group

8. DURING INFANCY & CHILDHOOD
 Sensory and motor skill development
 Communication skill (including speech and language)
 Self-help skills
 Socialization

9. DURING CHILDHOOD & ADOLESCENCE
 Application of basic academic skill to daily life activities
 Application of appropriate reasoning and judgement in the mastery of the
environment
 Social skills

10. DURING LATE ADOLESCENCE
 Vocational and social responsibilities and performance

11. EPIDEMIOLOGY
 3% of the world population
 10 out of 1000 children (as per 2021 data)
 More common in boys than girls
 Mortality is high in severe MR due to associated physical disease

12. ETIOLOGY

13. GENETIC FACTORS
Gross disease of brain
1. Tuberous scleroses
2. Neurofibromatosis
3. Epilepsy
Cranial
malformation
1. Hydrocephaly
2. microcephaly
Chromosomal
abnormalities
1. Down’s
syndrome
2. Fragile X
syndrome
3. Trisomy X
syndrome
4. Turner’s
syndrome
5. Cat-cry
syndrome
6. Prader-Will
syndrome
Metabolic disorders
1. Phenylketonuria
2. Wilson’s disease
3. Galactosemia

14. PRENATAL FACTORS
Intoxication
1. Lead
2. Certain drugs
3. Substance
abuse
Placental
dysfunction
1. Toxemia of
pregnancy
2. Placenta previa
3. Cord prolapse
4. Nutritional
growth
retardation
Physical damage
&disorders
1. Injury
2. Hypoxia
3. Radiation
4. Hypertension
5. Anemia
6. emphysema
Endocrine disorders
1. Hypothyroidism
2. Hypoparathyroi
dism
3. DM
Infections
1. Rubella
2. Cytomegalovirus
3. Syphilis
toxoplasmosis,
4. Herpes simplex

15. PERINATAL FACTORS
1. Birth asphyxia
2. Prolonged or difficult birth
3. Prematurity (due ton complication)
4. Kernicterus
5. Instrumental delivery (resulting in head injury,
intraventricular hemorrhage)

16. POSTNATAL FACTORS
Infections
1. Encephalitis
2. Measles
3. Meningitis
4. septicemia
Accidents Lead poisoning

17. ENVIRONMENTAL & SOCIO-CULTURAL
FACTORS
Inadequate
caretakers
Low socio-
economic status Child abuse
Cultural
deprivation

18. CLASSIFICATION OF MR
 Intelligence quotient (IQ) is the ratio between Mental Age
(MA) and Chronological Age (CA)
 While the chronological age is determined from the date of
birth, mental age is determined by intelligence test.

19. TYPE INTELLIGENCE
QUOTIENT (IQ)
Mild (Educable) 50-70
Moderate (Trainable) 35-50
Severe (Dependent
retarded)
20-35
Profound (Life support) < 20

20. BEHAVIOURAL
MANIFESTATION OF MR
CHIDREN

21. TYPE OF
RETARDATION/BE
HAVIORAL
MANIFESTATION
MILD RETARDATION
Self care ability The child may be able to live somewhat independently with
monitoring or assistance with life changes, challenges, or stressors
(such as personal illness or death of loved one)
Education level The child can achieve reading skills up to the level of primary
school and master vocational training
Social skills The child can learn and use social skills in structured settings
Psychomotor skills The child can develop average to good skills but may experience
minor co-ordination problems
Economic situation The child can perform a job under close supervision and manage
money with proper guidance

22. TYPE OF
RETARDATION/BE
HAVIORAL
MANIFESTATION
MODERATE RETARDAYTION
Self care ability The child requires close supervision and must be supervised when
performing certain independent activities
Education level The child can achieve skills up to second class and may be trained
in skills to participate in workshop setting
Social skills The child has certain speech limitations and difficulty following
expected social norms
Psychomotor skills The child have difficulty with gross motor skills and may have
limited vocational opportunities
Economic situation The child may learn to handle a small amount of pocket money as
well as how to make change

23. TYPE OF
RETARDATION/B
EHAVIORAL
MANIFESTATION
SEVERE RETARDATION
Self care ability The child requires complete supervision but may be able to perform
simple hygiene skills, such as brushing teeth and washing hands
Education level May learn a few simple skills
Social skills The child has limited verbal skills and tends to communicate needs non-
verbally or by acting them out
Psychomotor skills The child has poor psychomotor skills, with limited ability to perform
simple tasks even under direct supervision
Economic situation The child may be taught how to use money and supervised while
shopping

24. TYPE OF
RETARDATION/B
EHAVIORAL
MANIFESTATION
PROFOUND RETARDATION
Self care ability The child requires constant assistance and supervision
Education level The child can not benefit from academic training
Social skills The child has little speech development and lacks social skills
Psychomotor skills The child lacks both fine and gross motor skills
Economic situation The child must depend on others for money management

25. SIGN AND SYMPTOMS

26. Failure to
achieve
developmental
milestone
Expressive/
recessive
language
problems
Psycho-motor
skill deficit
Difficulty
performing
self care
activity
Deficiency in
cognitive
functioning
Reduced
ability to
meet
academic
demands

27. Medical
problems like
seizures
Neurologic
impairment
Acting out
behaviour
Irritability
when
frustrated or
upset
Low self
esteem,
depression,
labile moods
Lack of
curiosity

28. DIAGNOSIS
 History collection from parents and caretakers
 Physical examination
 Neurological examination
 Investigations
- Urine and blood examination for metabolic disorders
- Culture for cytogenic and biochemical studies
- Amniocentesis in infant chromosomal disorders
- Chorionic villi sampling
- Hearing and speech evaluation
- EEG, especially if seizures are present
- CT scan or MRI brain, e.g., in tuberous sclerosis
- Thyroid dysfunction test when cretinism is suspected
- Psychological test like Stanford Binet Intelligence Scale for Children for level of disability

29. INTELLIGENCE QUOTIENT
FORMULA

30. PROGNOSIS
 Prognosis has improved and institutional care is no linger
recommended
 These children are mainstreamed whenever feasible and are
taught survival skills
 A multidimensional orientation is used when working with
these children, considering their physiological, cognitive,
social and emotional development

31. TREATMENT MODALITIES

32. Behaviour
management
Environmental
supervision

33. Child’s
developmental
need and
problems

34. Programme that maximize
speech, language, cognitive,
psychomotor, social, self care
and occupational skills

35. Ongoing evaluation
for overlapping
psychiatric disorders

36. Family therapy to help
parents develop coping
skills and deal with
guilt and anger

37. Early intervention
programs for children
younger than 3 with
MR

38. PREVENTION
PRIMARY
PREVENTION
TERTIARY
PREVENTION
SECONDARY
PREVENTION

39. PRIMARY PREVENTION

40. Preconception
Immunization of
maternal rubella
Genetic
counseling- to
determine risk
of occurrence or
reoccurrence of
specific genetic
or chromosomal
disorders

41. Blood tests for
marriage
licenses can
identify presence
of vulnerable
diseases
Adequate
maternal
nutrition for
later
childbearing
Family planning

42. During Gestation
Prenatal care:
- Adequate nutrition,
fetal monitoring &
protection from disease
- Avoiding teratogenic
substances
Analysis of fetus for
possible genetic
disorders: Amniocentesis,
fetoscopy, fetal biopsy,
USG

43. Delivery by
expertise for
high risk
At Delivery
Apgar
scoring done
at 1 and 5
minutes
Close
monitoring
of mother,
child
Inj. Of
gamma
globulin to
Rh negative
mothers

44. Childhood
Proper nutrition
throughout
developmental
period and first
6 months after
birth
Dietary
restriction for
specific
metabolic
disorders
Avoidance of
hazards in
environment to
avert brain
injury

45. Secondary prevention

46. Early detection and treatment of
preventable disorders. E.g.
phenylketonuria and
hypothyroidism can be easily
treated at an early stage by
dietary control or hormone
replacement therapy
Early recognition of presence of
mental retardation. A delay in
diagnosis may cause unfortunate
delay in rehabilitation

47. Psychiatric treatment for
emotional and behavioral
difficulties

48. Tertiary prevention
Includes rehabilitation in
vocational, physical and social
areas according to level of
handicap. Its aimed at reducing
disability and providing optimal
functioning in child with MR

49. LEGALASPECTS CONCERNING
PERSON WITH MENTAL
DISABILITIES

50.  MR are treated as person with disabilities under Section of the Persons with
disabilities (Equal Protection of Rights and Participation) Act, 1995
 Indian railways and some state govt. have schemes for travel facility for
persons with disability
 The income tax Act allows deduction in respect of maintenance including
medical treatment of a dependent who is a person with disability which
includes MR and mental illness under Section 80DD

51. CARE AND REHABILITATION OF MR

52. The main elements include:
 Early detection and early stimulation of mental handicaps
 Regular assessment of MR person’s attainment and disabilities
 Advice, support and practical measures for families
 Provision for education, training, occupation or work appropriate
 Housing and social support to enable self care
 Medical, nursing and other services for those who require them as
outpatients, day patients or inpatients
 Psychiatric and psychological services

53. HINTS FOR SUCCESSFUL SKILL
TRAINING
 Divide each training activity into small steps and demonstrate.
 Give repeated training
 Give training repeatedly
 Start the training with what child already knows and then proceed to
skill that to be trained
 Use study material which is attractive
 Assess the child periodically like once in 4-6 months
 Child learns very slowly

54.  Vocational training
 Help for families
 Residential care
 Psychiatric services

55. PREVENTION OF EXPLOITATION
AND ABUSE OF PERSONS WITH
MENTAL DISABILITIES
- One of the most vulnerable group likely to get exploited
- Female persons are more vulnerable, hence legal services institutions
shall come to assist these affected person in preventing exploitation
including sexual abuse

56. Siddharth Jayakumar was diagnosed with cerebral palsy when he was six
days old. But instead of being cowed down by circumstances, he focused
on building a life where he would accomplish every goal
An experienced banker. A pioneering Certified Documentary Credit Specialist. A sought
after motivational speaker. Many achievements, one name – Siddharth Jayakumar from
Bengaluru