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Mental retardation refers to substantial
limitations in present functioning and it
manifests before the age of 18.

It is characterized by significantly sub
average intellectual functioning,
existing concurrently with related
limitations in two or more of the
following applicable adaptive skill

home living
social skills
community use
health and safety
functional academics
leisure, and work

 Mental retardation (MR) is defined
as significant intellectual or cognitive
limitations, and an inability to adapt
to the demands of everyday life.

(Sheerenberger (1983))

 Mental retardation (MR) refers to significantly sub average general intelligence that causes major difficulties in activities of daily living. and has manifested by age 18. .

Their IQ score ranges from 50–70. They can often acquire academic skills up to about the sixth-grade level. . They can become fairly self-sufficient and in some cases live independently. CLASSIFICATION MILD MENTAL RETARDATION Approximately 85% of the mentally retarded population. with community and social support.

 They can carry out work and self-care tasks with moderate supervision. . MODERATE MENTAL RETARDATION  About 10% of the mentally retarded population  Their IQ scores ranging from 35–55.  They typically acquire communication skills in childhood and are able to live and function successfully within the community in such supervised environments as group homes.

.  Many severely retarded individuals are able to live in a group home.SEVERE MENTAL RETARDATION  About 3–4% of the mentally retarded population .  Their IQ scores ranges from 20–40.  They may master very basic self-care skills and some communication skills.

PROFOUND MENTAL RETARDATION  Only 1–2% of the mentally retarded population  Their IQ scores under 20–25.  They may be able to develop basic self-care and communication skills with appropriate support and training.  Their retardation is often caused by an accompanying neurological disorder.  Profoundly retarded people need a high level of structure and .

AAMR CLASSIFICATION (on the basis of support and care )  Intermittent support  Limited support  Extensive support  Pervasive support .

. DIAGNOSTIC CRITERIA  MR is formally diagnosed by professional assessment of intelligence and adaptive behaviour.

i. DSM –IV diagnostic criteria  a) An IQ below 70  b) Significant limitations in two or more areas of adaptive behaviour (as measured by an adaptive behaviour rating scale. and more)  c) Evidence that the limitations became apparent before the age of 18 . self- help skills. communication.e. interpersonal skills.

American Association of Mental Retardation. (classification on the basis of ICD 10 and DSM –IV) Class IQ  Profound mental retardation :Below 20  Severe mental retardation :20–34  Moderate mental retardation :35–49  Mild mental retardation :50–69  Borderline intellectual functioning :70–80 .

ICD 10 F70-F79 F70 Mild mental retardation F71 Moderate mental retardation F72 Severe mental retardation F73 Profound mental retardation F78 Other mental retardation F79 Unspecified mental retardation .

du –chat) Syndrome  Phenylketonuria .ETIOLOGY 1.GENETIC FACTORS  Down syndrome ◦ Trisomy 21 ◦ Translocation of 21 and 15  Fragile X syndrome ◦ mutation of X chromosome  Prader Willi Syndrome  Cast’s Cry(cri.

Cont…  Rett’s disorder  Neurofibromatosis( neuro- cutaneous syndrome characterised by ‘cafe au lait spots’. optic gliomas and acoustic neuromas)  Adrenoleukodystrophy  Maple syrup urine disorder .

ACQUIRED AND DEVELOPMENTAL FACTORS prenatal period  Maternal chronic illness  Uncontrolled diabetes  Anaemia  Emphysema  Hypertension  Long term use of alcohol and narcotic substance  Viral infections .II.

prenatal period Cont…  Rubella (German measles)  Cytomegalic inclusion disease  Syphilis  Toxoplasmosis  Herpes simplex  AIDS  Foetal alcohol syndrome  Prenatal drug exposure  Complication of pregnancy .

perinatal period  Acquired childhood disorder  Infections  Iodine deficiency  Head trauma  Near Drowning  Cardiac arrest ( during anaesthesia ) .

perinatal period cont…  Asphyxia  Long term exposure of lead  Exposure to mercury  Intracranial tumours  Surgery  chemotherapy .

ENVIRONMENTAL AND SOCIOCULTURAL FACTORS  Family instability  Teenage pregnancies  Mental disorder in parents .III.

PSYCHOPATHOLOGY MR is the manifestation of a group of disorders of CNS function. including the hippocampus and the medial temporal cortex. .  Dysfunction is localized primarily to the cortical structures.

CLINICAL FEATURES Behavioural disturbances  Aggression  Self-injury  Defiance (disambiguation)  Inattention  Hyperactivity  Anxiety  Depression  Sleep disturbances .

.Behavioural disturbances cont…  Stereotypic behaviours  Difficult temperaments  Noncompliance  Hyperactivity  Disordered sleep  Colic  Poor social skills  Delays in play skills.

Language delay •Delayed expressive language •lack of expressive language .

toileting. and play skills  Prolonged and messy finger feeding often is accompanied by oral-motor in coordination  lack of interest in age-appropriate toys  imaginative play and reciprocal play with age-matched peers .Fine motor/adaptive delay  Significant delays in self-feeding.

Gross motor delay  Delays in gross motor development infrequently accompany the language and fine motor/adaptive delays  Subtle delays in gross motor acquisition. or clumsiness .

Neurologic and physical abnormalities  seizure disorders Physical Sensory examination  Visual impairment (refractive errors. and cortical blindness)  Hearing deficits . strabismus. cataracts. abnormal retinal pigmentation.

DIAGNOSTIC MEASUREMENTS  History and physical examination  DNA analysis  Karyotype at the 500 band level of resolution  Plasma amino acids  Urinary organic acids  Urinary muco-polysaccharides and oligosaccharides .

DIAGNOSTIC MEASUREMENTS….  Plasma 7-DHC (Smith-Lemli- Opitz syndrome)  Thyroid function tests  Very-long-chain fatty acids  Creatine kinase .

Imaging Studies  BrainMRI  Head CT scan  Skeletal films .

and sustained attention . Other Tests PSYCHOLOGICAL ASSESSMENT  Bayley Scales of Infant Development ◦ Normalized for ages 2-30 months ◦ Subtest scores for receptive and expressive language. nonverbal problem-solving ability.

 Stanford-Binet Intelligence Scale ◦ Normalized for ages 2 years to 23 years ◦ Fifteen subtests for assessment of 4 key areas of cognitive proficiency: verbal reasoning. abstract/visual reasoning. and short-term memory . quantitative memory.

25 years ◦ Twelve subtests for assessment of verbal and nonverbal intelligence . Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R) ◦ Normalized for ages 3 years to 7.

11 months ◦ Verbal and nonverbal intelligence scores derived from 12 subtests . Wechsler Intelligence Scale for Children–IV (WISC-IV ◦ For ages 6 years to 16 years.

 Vineland Adaptive Behaviours Scales ◦ For neonates to adults ◦ Measures ability to perform daily activities required for personal and social sufficiency. adaptive or functional behaviours rated by interviewing the child's guardian  Deficiencies in at least 2 areas of adaptive skills required to meet the MR diagnostic criteria .

if clinically warranted  Auditory evoked potentials in the context of audiologic assessment  Visual evoked potentials in cases of profound delay and suspected cortical blindness .ELECTROPHYSIOLOGICAL STUDIES  EEG.

MANAGEMENT Primary prevention Eliminate or reduce conditions that lead to the disorders associated with mental retardation.  Family and genetic counselling  Education to increase general public knowledge  Prenatal and postnatal medical care  Supplementary enrichment programs .

communication and quality of life. vocation.Secondary and tertiary prevention Education for the child  It should include training in adaptive skills . . social skills.

Behavioural therapy  To shape and enhance social behaviours  To control and minimize aggressive and destructive behaviour  Positive reinforcement for desired behaviours  Benign punishment( loss of privileges .

Cognitive Therapy  dispelling false beliefs and relaxation exercise with self instruction Psychodynamic Therapy  Used with patients and their family members to decrease conflicts about expectations that result in persistent anxiety rage and depression .

anguish.Family education  The parents may benefit from the continuous counselling or family therapy should be allowed opportunities to express their feelings of guilt. despair. recurring denial and anger about their child disorder and their future .

Social intervention  Improving the quantity and quality of social competence  E.: special Olympic international .g.

PHARMACOLOGICAL Vitamin and mineral therapies CNS stimulants  psycho stimulants are prescribed because of the coexistence of attention deficit with or without hyperactivity disorder in as many as 50%.  The most widely used psycho stimulants are methylphenidate and .

Bupropion Alpha-adrenergic agonists  These agents are used commonly to modulate hyperactivity.g.Antidepressants  These agents may be used when ADHD is co morbid with depression.  E. Clonidine hydrochloride  Guanfacine .  E.g. tics. aggression. and dyssomnias.

g. and hyperactivity in people with MR. Risperidone.Neuroleptic drugs (antipsychotics)  The Neuroleptic drugs are the most frequently prescribed agents for aggression. they are more likely to be reserved for the older child or adult in whom intensive behavioural intervention has failed.  E. Increasingly. Aripiprazole . Haloperidol. self-injury.

feelings of helplessness.Nursing management  Ineffective Health Maintenance (Inability to identify.  Risk for self-directed violence related to depressed mood. hopelessness. patient verbalizes suicidal thoughts and feelings . manage. and/or seek help to maintain health)  Chronic low self-esteem related to ineffective or inadequate coping skills .

. Follow-up  Individuals with MR should be evaluated at least annually by a neurologist or neurodevelopment paediatrician with a special interest in the etiology and management of cognitive disorders.