Mental Retardation


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Mental Retardation

  1. 1. Mental Retardation Dr. Kalpana Malla MD Pediatrics Manipal Teaching HospitalDownload more documents and slide shows on The Medical Post [ ]
  2. 2. Definition (AAMD)• American Association on Mental Deficiency : Mental retardation refers to significantly sub average general intellectual functioning, existing concurrently with deficits in adaptive behavior and manifested during the developmental period
  3. 3. • Intellectual functioning is defined by Intelligent Qutient (I.Q) IQ = Mental Age/Chronological Age X100
  4. 4. Wechsler Adult Intelligence Scale (WAIS) Class IQ• Profound MR --------------------- <20• Severe MR ----------------------- 20-34• Moderate MR ------------------- 35-49• Mild MR -------------------------- 50-69• Boderline MR --------------------70-79• Low average---------------------80-89• Average --------------------------90-109• High average ------------------110-119• Superior -------------------------120-129• Genious ------------------------ > 130
  5. 5. Revised definition -1992• Does not consider IQ• Considers defects in adaptive skills- It is characterized by significantly subaverage intellectual functioning, existing concurrently with related limitations in two or more of the following applicable adaptive skill areas:1.Communication2. Self-Care- getting dressed, using the bathroom, and feeding oneself3. Home Living
  6. 6. Revised definition -19924. Social Skills - peers, family members, spouses,5. Community Use6. Self-Direction7. Health And Safety8. Functional Academics9. Leisure And Work• Mental retardation manifests before age 18.
  7. 7. • Two areas of deficits - intellectual functioning and adaptive skills :• Intellectual skills, the ability to solve problems related to academics; usually estimated by an IQ test• Adaptive skills, skills needed to adapt to one’s living environments; usually estimated by an adaptive behavior survey
  8. 8. Alternative terms• Developmental delay• Developmental disability• Intellectual disability• Mental handicap• Learning difficulty• Idiots• Morons• Mental Defectives• Feeble-minded• Fools• Evolutionary Degenerates
  9. 9. Causes by time.• Prenatal (12%) -occurs during fetal development• Perinatal (6%) -causes at birth• Postnatal (4%) - occurring after birth, can be biological or psychosocial• 78% unknown
  10. 10. • Prenatal :A)Structural defects – hydrocephalus,spina bifida,craniosynostosis, microcephalyB)Genetic conditions 1. chromosomal disorders –down syndrome ,fragile X syndrome Klinfelters syndrome
  11. 11. Prenatal2.Inborn errors of metabolism – a) Amino acid - Phenylketonuria, Maple syrup urine Ds,Homocystinuria,Hartnup ds b) Carbohydrate metabolism –glactosemia,Fructose intolerance, Glycogen storage ds, MPS c) Lipid metabolism - lipidosis, Tay sachs Ds,C. Endocrine – cretinism
  12. 12. PrenatalD) Maternal – TORCH infection - Fetal alcohol syndrome, Teratogenic agents, irradiation, Toxemia of pregnancy
  13. 13. Causes by timePerinatal• Birth Asphyxia• Birth trauma• Intracranial hge• Low birth weight• Prematurity• Torch• Meningitis at birth
  14. 14. Causes by timePostnatal-• Infection -Meningitis, Encephalitis• Toxic – kernicterus ,Lead intoxication• Trauma - Head injuries ,ICHge ,Child abuse and neglect• Endocrine –hypoglycemia ,hypocalcemia, dyselectrolytemia,hypothyroidism• Gross PEM
  15. 15. Postnatal……..• Behavioral injuries - Social and family, interactions• Educational availability & supports that promote mental development of adaptive skills• Social, behavioral, and educational often overlap these are sometimes referred to as cultural-familial mental retardation
  16. 16. Causes by severity• Mild MR is more influenced by cultural and family environment – PHYSIOLOGICAL MR• More severe MR is more likely to stem from genetic and other organic factors – PATHOLOGICAL MR
  17. 17. Syndromes associated MR• Down syndrome -MR, slanted eyes, single palm crease, hypotonia, short stature• Fragile X Syndrome – in males, thought to be most common hereditary cause of MR• Tay-Sachs Disease - inherited metabolic disorder which leads MR, paralysis, dementia, or blindness
  18. 18. Syndromes associated MR• Williams syndrome –mild to mod MR (social deficits in special skills, reading, math, writing), heart defects, elfin facial features• Prader-Willi syndrome - MR varies, mostly mild MR, obesity
  19. 19. Signs• Have trouble speaking• Find it hard to remember things• Have trouble understanding social rules• Have trouble learn specific subject• Have trouble solving problems• Have trouble thinking logically• Disable to self care• Persistence of infantile behaviour• Unable to take higher education
  20. 20. Mild MR• Learning disabilities ,hyperactivity, short attention span, distractibility, poor concentration, poor memory, impulsiveness, clumsy movements, disturbed sleep• Emotional instability, low frustration tolerance
  21. 21. • Mild disability – May not be obvious in early childhood In School - have poor academic performance ( learning disability) In adults - considered as "slow" rather than retarded
  22. 22. Moderate MR• Academic skills – 2nd grade level• Problem with social work• Behaviorable age -8 yrsobvious within 1st year of life - 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
  23. 23. Severe MR• Little or no speech• Limited abilities to manage self care• Require high supervision• Behaviourable age – 3 yrs
  24. 24. Diagnosis• According to the latest edition of the Diagnostic and statistical Manual of Mental Disorders there are three criterias1. IQ below 702.Significant limitations in two or more areas of adaptive behavior3. Evidence that the limitations became apparent in childhood
  25. 25. Assessment• Assess intellectual and adaptive skills• Professional administered IQ tests - Stanford-Binet – 2yrs - adult - Wechsler Intelligence Scale for Children (WISC-III) – 6- 17 yrs - Kaufman Assessment Battery for Children (K-ABC)
  26. 26. Prenatal Screening• Amniocentesis (fluid)• Chorionic villus sampling (CVS) (tissue)• Sonography (visual)• Maternal serum screening (MSS) (blood)
  27. 27. Investigations• No routine workup• Clinical judgement• No identifyable cause in most cases• Some – chromosomal, metabolic, encephalopathy• Investigations – TORCH screening Karyotyping thyroid function test metabolic screening CT/MRI EEG
  28. 28. Treatment• Require patience, good will, unlimited time• Caring rather than curing• Educating rather than medicating
  29. 29. Instruction Using Behavioral Principles• Caregivers are trained to teach children positive behaviors and reduce negative behaviors effectively and humanely
  30. 30. 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
  31. 31. Mainstreaming• Placing children with MR in regular classrooms to “normalize” their behavior and give them more opportunities• Students with MR achieve high academic gains where they are more fully included in general classrooms
  32. 32. Institutionalization• Reserved for the least capable children with the gravest disabilities
  33. 33. Milder MR is usually More severe MR is treated with treated by:• 1. Behavioral • 1. Behavior Therapy Instruction • 2. Drugs to control• 2. Early Intervention aggression and self- Programs injurious behavior• 3. Special Education • 3. Either home care or• 4. Mainstreaming institutionalization
  34. 34. Treatable /Preventable causes of MR• Hypothyroidism• Severe PEM• Perinatal asphyxia• Preterm /LBW• Meningitis, encephalitis
  35. 35. Prevention• Primary intervention before it occurs…(vaccines for rubella)• Secondary intervention soon after detection (lead screening, PKY screening)• Tertiary intervention to reduce long term effects (early education intervention)
  36. 36. ASSOCIATED PROBLEMS• Self injury • Eating problems• Pica • Poisoning• CP • Sexual abuse• Epilepsy • Learning disorders• Toilet probs • Behavior problems• Sleep disorders
  37. 37. Thank youDownload more documents and slide shows on The Medical Post [ ]