LEARNING DISABILITY

(MENTAL RETARDATION)
Elmeida Effendy
Department Psychiatry

TERMINOLOGY
IDIOT

= SEVERE INTELLECTUAL
IMPAIRMENT
IMBECILE= MODERATE IMPAIRMENT
MENTAL DEFICIENCY
STIGMA
MENTAL SUBNORMALITY
MENTAL RETARDATION
ICD 10 & DSM IV
MENTAL HANDICAP
LEARNING DISABILITY >> UK
US: LEARNING DISABILITY APPLIED TO
DYSLEXIA

AETIOLOGY
GENETIC

FACTORS

CHROMOSOME
FRAGILE

ABNORMALITIES

SITE
TRISOMY 21
TRISOMY 18
MICRODELETIONS
METABOLIC DISORDER AFFECTING :
AMINO ACID, UREA, LIPID,
CARBOHYDRAT

 INBORN

ERRORS OF METABOLISM

PHENYLKETONURIA
HOMOCYSTINURIA
GALACTOSEMIA
TAY-SACHS-

DISEASE
HURLERS SYNDROME
LESCH-NYHAN SYNDROME

 ANTENATAL DAMAGE

INFECTIONS (RUBELLA, CYTOMEGALOVIRUS,

SYPHILIS, TOXOPLASMOSIS)
INTOXICATIONS (LEAD, ALCOHOL, CERTAIN
DRUGS)
PHYSICAL DAMAGE (INJURY, RADIATION,
HYPOXIA)
PLACENTAL DYSFUNCTION (TOXAEMIA)
ENDOCRINE DISORDER(HYPOTHYROIDISM)

 PERINATAL
BIRTH

DAMAGE

ASPHIXIA
COMPLICATION OF PREMATURITY
KERNICTERUS
INTRAVENTRICULAR HAEMORRHAGE

 POSTNATAL
INJURY

DAMAGE

(ACCIDENTAL, CHILD ABUSE)

INTOXICATION (LEAD MERCURY )
INFECTIONS (ENCEPHALITIS,
MENINGITIS)
IMPOVERISHED ENVIRONMENT

CLINIAL FEATURES
LOW

PERFORMANCE ON ALL KINDS

OF INTELLECTUAL TASKS
INCLUDING LEARNING, SHORT TERM
MEMORY, THE USE OF CONCEPTS &
PROBLEM SOLVING
COMMON BEHAHAVIOUR PROBLEM

MILD LEARNING DISABILITY

IQ

RANGE 69-50
PERCENTAGE OF CASES 85 %
ABILITY TO SELF CARE : INDEPENDENT
LANGUAGE : REASONABLE
READING & WRITING : REASONABLE
ABILITY TO WORK : SEMI SKILLED
SOCIAL SKILLS : NORAL
PHYSICAL PROBLEM : RARE
AETIOLOGY DISCOVERED : SOMETIMES

MODERATE LEARNING DISABILITY

IQ RANGE 49-35
PERCENTAGE OF CASES : 10 %
ABILITY TO SELF CARE : NEED SOME HELP
LANGUAGE : LIMITED
READING & WRITING : BASIC
ABILITY TO WORK : UNSKILLED, SUPERVISED
SOCIAL SKILLS : MODERATE
PHYSICAL PROBLEMS : SOMETIMES
AETIOLOGY DISCOVERED : OFTEN

SEVERE /PROFOUND LEARNING

DISABILITY

SEVERE LEARNING DISABILITY : IQ 20-34

PROFOUND LEARNING DISABILITY : IQ BELOW 20
PERCENTAGE OF CASES : 5 %
ABILITY TO SELF CARE :LIMITED
LANGUAGE : BASIC OR NONE
READING & WRITING : MINIMAL OR NONE
ABILITY TO WORK : SUPERVISED BASIC TASKS
SOCIAL SKILS : FEW
PHYSICAL PROBLEMS : COMMON
AETIOLOGY DISCOVERED : USUALLY

FEATURES OF DOWN SYNDROME

MODERATE OR SEVERE LEARNIG DISABILITY

PLACID TEMPERAMENT
PHYSICAL FEATURES

SLANTED EYES 7 EPICANTHIC FOLDS

SMALL MOUTH WITH FURROWED TONGUE
FLAT NOSE
FLATTENED OCCIPIT
STUBBY HANDS, FINGERS & SINGLE PALMAR CREASE
HYPOTONIA

ASSOCIATED MEDICAL PROBLEMS

CARDIAC, GI ABNORMALITIES,IMPAIRED HEARING