1. The document discusses intellectual and developmental disabilities and provides outdated terminology should no longer be used. 2. It presents a lesson plan on caring for patients with intellectual disabilities, covering definitions, causes, assessments, classifications, and nursing management. 3. Nursing diagnoses for patients with intellectual disabilities include risks for injury, impaired communication, self-care deficits, and caregiver role strain. Nursing management focuses on individualized care, developing skills, and collaborating with family.

1. S . D. Bulathsinghala
Special Grade Nursing Tutor
School of Nursing Mental
Health
Mulleriyawa

2. Intellectual or developmental disabilities.
 However, it's important to note that the term
"mental sub normality" is an outdated and
potentially offensive term that is no longer used in
professional healthcare contexts. Instead,
contemporary healthcare professionals use more
respectful and clinically appropriate terminology to
describe conditions related to intellectual or
developmental disabilities.

3. Lesson Plan
 Name of the Presenter - Mrs. S.D Bulathsinghala
 Subject - Psychiatric Nursing
 Topic - Mental sub normality
 Participants -Nursing student(diploma)
 Time - 3 hours
 Teaching activity - Lecturer ,discussion
 Evaluation -Answering the questions

4. General Objectives
 At the end of this session Nursing students should be able to
appreciate the knowledge when caring of the patient with
mental sub normality
 Specific Objectives
 After Completion of this lesson nursing students will be able to
 .Define mental sub normality
 . Describe intellectual function and adaptive functioning
,

5. Specific objectives Cont….
 Describe signs of developmental delay
 Describe causes for mental sub normality .
 Describe, diagnostic evaluation and management
of sub normality
 List out the classification of mental sub normality

6. Specific Objectives cont…
 Describe, diagnostic evaluation and management of
sub normality
 List out the classification of mental sub normality
 Describe the preventive methods of sub normality
 Appreciate the nursing care and rehabilitation of sub
normality

7. Mental sub normality
 Mental sub normality or Mental retardation is a state
of developmental deficit that begins in childhood and
result in significant limitation of intellect and poor
adaptation to the demands of every day life

8.  Mental retardation refers to significantly sub-average
general intellectual functioning resulting in or
associated with concurrent impairments in adaptive
behavior and manifested during the developmental
period
(American Association on Mental Deficiency 1983)

9.  Mental retardation is
defined by deficits in
general intellectual
functioning and adaptive
functioning (APA, 2000)

10. several terms have been used to denote this condition
such as ,
•Mental sub normality
•Mental retardation
•mental handicap,
•mental deficiency
•Mental impairment

11. •Intellectual
deficiencies
•Intellectual
disability
•Learning
difficulties
•Learning
disability
•Amentia –
severe mental
disability

12.  Mental Sub Normality is not a disease but a condition in
which….lack of General intellectual functioning and
adaptive functioning
 It presents from birth – developmental period (birth – 18
years) Developmental delays are failure to achieve age-
appropriate skills) are evident to some degree in almost all
areas.
 Motor developmental delays
 Cognitive developmental delay

13.  Adaptive functioning
Refers to the person’s ability to adapt to the requirements of
daily living and the expectations of his or her age and cultural
group.
• Ex -Being able to communicate effectively
• Interact with others
• Take care of one self.
• Daily living skills at home ,in the community . Or social skills

14.  Intellectual functioning is determined by many factors.
 However, a primary source of this capacity is mental
ability or "intelligence."
 Intelligence refers to the ability to reason, plan, think, and
communicate.
 These abilities allow us to solve problems, to learn, and to
use good judgment.

15. Intellectual disability involves problems with general
mental abilities that affect functioning in two areas:
 Intellectual functioning (such as learning, problem
solving, judgments)
 Adaptive functioning (activities of daily life such as
communication and independent living)

16. Intellectual functioning
Also known as IQ,
This refers to a person’s ability to
Learn
Reason
Make decisions
Solve problems

17. General intellectual functioning
is measured by an individual’s performance
on intelligence quotient (IQ) tests.
Intelligence quotient
(IQ ) tests = Mental Age (MA ) x 100
Chronological Age (CA)

18.  How can I know my mental age?
 Mental age, intelligence test score, expressed as the
chronological age for which a given level of
performance is average or typical.
 An individual's mental age is then divided by his
chronological age and multiplied by 100, yielding an
intelligence quotient (IQ).

19. SIGNS OF DEVELOPMENTAL DELAY
 Infancy
 Poor feeder, a weak or uncoordinated suck
 Results in poor breast- or bottle-feeding,
 leading to poor weight gain
 Delayed or decreased visual alertness and
 Curiosity with poor visual tracking of face or
objects

20. SIGNS OF DEVELOPMENTAL DELAY
CONT…..
Communication and Feeding
 Feeding difficulties weak sucking or poor coordination of
suck-swallowing to sustain normal weight gain
 No social smile by age 4 months
 No babbling (ga-ga, da-da) by age 9 months
 No Mama, Dada (specific) by age 14 months

21. Cont…….
 No name of object (one word) by age 14 months
At least 10 words by age 18 months (not just repeating)
•Combines words (eg, me outside, more milk) and
uses pronouns by age 24 months
•Regression in language at any age
•Unresponsive to his name

22. Cont…..
Motor Delay
 Not rolling over by age 6 months
 Not sitting by age 9 months
 Not walking by age 15 months
 Not stair-climbing by age 2 years

23.  Most Common Types of Intellectual
Disabilities
 Autism. Autism is an intellectual disability
affecting the nervous system and the
structure and function of the brain. ...
 Down's Syndrome. ...
 Fragile X Syndrome. ...
 Fetal Alcohol Syndrome. ...
 Prader-Willi Syndrome (PWS)

24. •Genetic factors
•Chromosomal disorders
Eg: Down’s syndrome,
Turner syndrome is a genetic disorder found in
females.
•Metabolic disorders
Eg: Phenylketonuria, Wilson’s disease
•Cranial malformations
Hydrocephaly , Microcephaly
Causes for Mental Sub normality

25. Pre natal factors (from conception to birth)
•Infections (Torches)
• Endocrine disorders
Ex: Diabetic mellitus, Hypothyroidism
•Physical damage and disorders
Ex : Injury, Hypoxia, Hypertension, Anemia, heart and
kidney disease

26. Pre natal factors contd…..
 Intoxication
Eg: Drugs, Lead, alcohol, cigarette smoking
 Placental dysfunction
Eg : Placenta Previa, Cord prolapse, Nutritional
growth retardation

27. Perinatal factors(During the delivery)

Birth asphyxia
 Prolonged or difficult birth
 Prematurity
 Very low birth weight
 Instrumental delivery(head injury, intra ventricular
hemorrhage)

28.  Postnatal factors (infancy and childhood)
•Infections (Japanese encephalitis, bacterial meningitis
, brain infection , tuberculosis)
• Jaundice(develop kernicterus)

29.  Postnatal factors cont.….
•Hypoglycemia
• Neonatal convulsion
• Head injury
• Lead poisoning
• Severe prolonged malnutrition

30. Classification of Mental Sub normality
 Mental retardation comprises five general
categories:
 Mild mental Sub normality
 Moderate mental Sub normality
 Severe mental Sub normality
 Profound mental Sub normality

31. Classification of Mental Sub normality
 Mild (educable) 50-70%
 Moderate (trainable) 35-50%
 Severe (dependent) 20-35%
 Profound (life support) <20%

32. Mild mental sub normality
 IQ level 50-70 %
 Commonest type (80 -90%)
 Good in psychomotor skills
 Able to do self care and domestic skills
 (eating, washing, dressing, bladder, bowel control)
 Ability to use the language for everyday purposes

33. Moderate MS-Coping abilities
 IQ 35-50 %
 Found 10 %
 Need supervision for self care (Motor skills are slow)
 Learn few basic skills. unaware of needs
 Epilepsy, physical and neurological disabilities are common

34. Moderate MS contd…….
 Limitation of speech
 Education up to grade 2
 Require supervision throughout the life
 Can handle small amount of money with supervision

35. Severe Mental Sub normality
 Found 3-4%
 Recognized early in life
 IQ 20 -35%
 Motor impairment
 Minimal speech and communication
 Poor psychomotor skills
 Limited ability to perform simple task

36. Severe Mental sub normality contd…..
 Motor impairment indicating mal development
of central nervous system
 Self care with assistance
 May learn to perform simple working
 Need complete assistance and supervision

37. Profound Mental Sub normality
 IQ 20 % or below
 Found 1-2%
 Can’t comply with request or instructions
 Most of them are immobile and incontinent
 Need institutional care
 Little non verbal communication
 Totally dependent for physical care and basic needs

38. Identify MS in early childhood
Infancy
 Poor feeding
 Poor weight gain
 Decreased visual attention and auditory response
 Delayed head and trunk control
 Poor mother – child interaction

39. Identify MS in early childhood
Toddler
 Delayed speech
 Language disabilities
 Delayed motor
milestones
 Short attention span
 Poor memory
 Sleep problems
 Emotional instability

40.  contd…..
 Toddler
 Delayed independent sitting, crawling, pulling to stand,
and independent ambulation.
 failure to develop receptive and expressive language
milestones.

41.  Cont….
 Almost 50% of children with mental retardation are
identified after age 3, when
 speech delays manifest themselves.

42. Diagnosis of MS
History taking
Physical examination
Neurological examination
Assess developmental milestone
Investigations – EEG, CT ,Thyroid function
test
Evaluations – Hearing test ,Speech evaluation
psychological test

43. Management
 An interdisciplinary team evaluation by a
developmental pediatrician, clinical psychologist,
and counselor is usually the initial step in the
management of mental retardation.
 .Prevention is better than cure

44. Prevention of Sub normality
Primary prevention
Secondary prevention
Tertiary prevention

45. Primary prevention
Preconception
Genetic counseling
Immunization
Eg : Rubella
Blood test
Eg: STD
Adequate nutrition
Family planning

47. During Gestation
Analysis of fetus for
 genetic disorders
 Vaccination
Nutrition
Tender loving care
Spirituality

48. Perinatal care (at delivery)
Expert delivery care
Expert postnatal care
Close monitoring

49. Post natal care
Childhood
Proper nutrition
Avoid environmental hazards

50. Secondary Prevention (Early
diagnosis and treatment)
Early detection and treatment of the
preventable disorders
Amniocentesis and medical
termination of pregnancy
Early detection of correctable disorder
Prevent them against abuse

51. Tertiary Prevention
Disability limitation
Treatment of physical and psychological
problems
Institutionalization of severe mentally retarded
or those with psychological problems
Education and training to avoid handicaps
Physiotherapy to treat the associated deficits
Rehabilitation

52. Skills training
 Divide each training activity in to small steps
and demonstrate
 Give repeated training in each activity
 Give training regularly and systematically
 Start with what child already knows
 Rewards and appreciate the child

53. Skills training contd….
Start with what child already
knows
Rewards and appreciate the child

54. Skills training contd….
 Use training material which are attractive,
appropriate and locally available
 Try to involve with normal children in same
age
’

55. Skills training contd…
•No age limit for training
•Asses child once in
4 or 6 months
• Keep in mind ‘THEY LEARN VERY SLOWLY

56. Skills training

57. Effects of MS on Family
 Depression, guilt, shame or anger
 Rejection of child
 Overindulgence
 Social problem
 Marital disharmony
 Burden of care for their child

59. Nursing diagnosis
 "mental sub normality" is an outdated and
potentially offensive term that is no longer used
in professional healthcare contexts. Instead,
contemporary healthcare professionals use more
respectful and clinically appropriate terminology
to describe conditions related to intellectual or
developmental disabilities.

60. Nursing Diagnosis
 Risk for Injury: Patients with intellectual or
developmental disabilities may be at a higher risk
of injury due to impaired coordination, sensory
deficits, or difficulty understanding safety
instructions.

61.  Impaired Communication: Many individuals with
these disabilities may have difficulty expressing
themselves or understanding verbal communication,
which can affect their ability to convey their needs
and understand medical instructions.

62. Nursing Diagnosis
 Self-Care Deficit: Some patients with intellectual or
developmental disabilities may require assistance with
activities of daily living, such as bathing, dressing, or
feeding
 Social Isolation: Patients with these disabilities may
experience social isolation due to communication
challenges, stigmatization, or limited social
opportunities.

63. Nursing Diagnosis
 Impaired Mobility: Mobility issues, such as
difficulty walking or moving, may be present in some
individuals with developmental disabilities, which can
impact their independence and quality of life.

64. Nursing Diagnosis
 Risk for Malnutrition: Patients with intellectual or
developmental disabilities may have difficulty
with feeding or making healthy dietary choices,
putting them at risk for malnutrition.

65. Nursing Diagnosis
 Impaired Coping: Some individuals with these
disabilities may struggle with emotional regulation or
have difficulty coping with stress and changes in
their environment.

66. Nursing Diagnosis
 Caregiver Role Strain: This diagnosis can be
relevant when family members or caregivers
experience physical or emotional strain in caring for
someone with an intellectual or developmental
disability.

67. Nursing Management
 Make highly individualized, long term goals depend
on the level of retardation
 Goal should be realistic
 Parent involvement is essential

68. Cont……
Identify child’s strengths and
abilities
Monitor the child’s developmental
levels, needs and problems
 Behavior management

69. Nursing Management contd….
Environmental supervision
Provide safety needs.
Prevent self-injury

70. Nursing Management contd….
Maximize speech, language,
cognitive, psychomotor, social, self
care and occupational skills
Teach adaptive skills such as eating,
dressing, grooming and toileting

71. Nursing Management contd….
Ongoing evaluation for overlapping
psychiatric disorders such as
depression, bipolar disorder and ADHD
Early intervention programs for
children younger than 3years with
mental retardation

72. Nursing Management contd…
Provide facilities to schooling
Stimulate the child

73. Nursing Management contd
Maximize speech, language, cognitive,
psychomotor, social, self care and
occupational skills
Teach adaptive skills such as eating,
dressing, grooming and toileting

74. Teach him about natural and normal
feelings and emotions
Help to learn social skills, norms and
behaviors

75. Nursing Management contd…..
Family therapy to help parents develop
coping skills and deal with guilt or
anger
Monitor the child for physical or
emotional distress

76. Nursing Management contd…..
Assist adolescence for productive
work life
Emphasize sexual behaviors with
both child and family.

77. Nursing Management contd…..
•Prevention of exploitation and
abuse and advice for legal services
•Close collaboration with all
members of the therapeutic team
for successful outcome

78. Summery
1. Define mental
sub normality
2. Describe
intellectual
function and
adaptive
functioning

79. 3. Describe causes, clinical features, diagnostic
evaluation and management of sub
normality
4. Describe classification of sub normality
5. List out preventive methods of sub
normality
6 . Describe Nursing care management for
sub normality
Summery

81. THANK YOU