1. Mental retardation is defined as deficits in general intellectual functioning and adaptive functioning, as measured by IQ scores and ability to adapt to daily living. 2. There are five types of mental retardation - mild, moderate, severe, borderline, and profound - defined by IQ scores and levels of independence. Mild accounts for 85-90% of cases. 3. Causes include genetic conditions, biochemical/metabolic disorders, prenatal and perinatal issues, health problems in early childhood, sensory deprivation, brain disorders, and miscellaneous conditions. Predisposing factors are related to socioeconomic status, environment, and care quality during development.

1. Prof. (Dr.) Rahul Sharma
Professor
H.O.D. of Mental Health Nursing
Ph. D Coordinator
Seedling School of Nursing,
Jaipur National University,
Jaipur

2. Mental Retardation:
It is defined by deficit in general intellectual
functioning and adaptive functioning.
General intellectual functioning is measured by an individual
performance on intelligence quotient (IQ) test.
Adaptive functioning refers to the person ability to adapt to the
requirement of daily living including thinking, learning, social and
occupational adjustment.

3. Types of Mental Retardation:
1. Mild: 85-90 % of total mental retardation cases belong to mild mental
retardation with IQ 51-70 level.
Environmental influence, malnutrition, socio-economic class are the
causes for mild mental retardation.
They have deficit in intellectual skill, studies up to 6th- 8th standard. Problem
inn reading, writing, difficulty in academic school work, normative living skill,
walking, talking, toilet training, language ability, behavior, social and
emotional adjustment like a normal person.
2. Moderate: 10 % of mental retardation cases belong to moderate mental
retardation with 35-50 IQ level.
Children can be trainable aimed at self help skill, they can speak and support
themselves, able to perform semiskilled work under supervision.
Communication skill develop much slowly, limited progress in school work,
studies up to 2nd grade.

4. Types of Mental Retardation:
3. Severe: 7 % of total mental retardation cases with IQ 21-35 level,
slow motor development in preschool years, trainable for normal living
activities, some children may learn social behavior, able to
communicate in simple way, delay speech and communication skill.
4. Boderline: IQ level is 70-90. early development is normal, many of
them belong to low socio economic groups.
5. Profound: 1-2 % of all mental retardation cases with 0-20 IQ level.
Considerable organic pathology, nervous system damaged to noticed,
associate condition are blindness, deafness, seizures are common.
Totally dependent, death may occur due to variety of problem or
complication.

5. Predisposing Factor:
 Low socioeconomic poverty
 Low birth weight of the child
 Advanced maternal age
 Extreme malnutrition
 Lack of stimulating environment
 Poor sensory experience
 Low standard education
 Psychosocial disadvantage- poor health practice, poor housing
 Child Abuse
 Prolonged isolation of care taker during developmental period.

6. Causes:
1. Genetic Condition: Abnormal genes will be inheriting from parents,
error when gene combine or for other reason. Ex. Down syndrome.
2. Biochemical factors or metabolic disorder: Amino acid ex. Phenyl
ketonuria
3. Prenatal cases: Physical damage ex. Injury, hypoxia, radiation,
poisoning. Endocrinal disorder ex. Hypothyroidism, diabetes
mellitus, malnutrition, anemia, hypertension, alcohol and drugs.
4. Problem during birth: Prematurity, low birth weight, Hypoxia,
problems during labor and birth ex. Not getting enough oxygen.
5. Perinatal insults: Hypoxia, meningitis, trauma, dehydration.
6. Health problems of young child: Whooping cough, measles and lead
poisoning.

7. Causes:
7. Sensory Deprivation: Environmental restriction, isolation for long
time.
8. Brain Disorder: Epilepsy, head injury, stroke, meningitis, brain tissue
damage.
9. Miscellaneous Condition: CNS malformation, Neurotic Syndrome and
Migration defect.

8. Clinical Manifestation:
1. In Infancy-
 Poor feeding lead to poor weight gain.
 Delay visual alertness & curiosity
 Decrease auditory response
 Delayed head and trunk control
 Delayed development in motor skill
2. In Toddler-
• Delayed independent living skill, sitting
• Delayed communication failure, delayed speech, slow to use
words.
• Slow to learn, self care

9. Clinical Manifestation:
• Cognitive impairment
• Behavioral disturbance
• Impaired ability to communicate to others.
3. Others:
 Seizures
 Lethargy
 Vomiting
 Abnormal urine odor
 Failure to feel and grow normally
 Anxiety and depression

10. Diagnostic Evaluation:
 Complete history is collected from family members and care takers
 Mental history
 Physical Examination
 Neurological Assessment
 Urine & blood test
 Hormonal studies- T3, T4
 CT scan & MRI
 Sensory test- assessment for vision, hearing
 Education evaluation- Reading, writing
 Psychological investigation- personality assessment

11. Medical Management:
 Chlorpromazine and haloperidol (to control stereotype motor
abnormalities)
 Antipsychotics, sodium valproate, lithium carbonate, naltrexone and
carbamazepine (to control aggression)
 Stimulants such as amphetamine and methylphenidate (for
inattentive).
Multidisciplinary team will formulate treatment strategies.
Team consist of psychiatrist, neurologist, pediatricians, occupational
and physical therapist, speech therapist, social worker, nurse, nutrition
expert, educators and other (Family).