Normal Milestones

IQ-Levels of IQ
Mental Retardation

By-Dr.P.SWETHA
MODERATER-Dr.SAI NAVEEN
 NORMAL MILESTONES

• Normal development is a complex process and

assessed under following domains:
• GROSS MOTOR
• FINE MOTOR
• LINGUAL
• SOCIAL
• VISION AND HEARING
2 Mon- social smile
• 3 Mon: • 6 mo
• GM:Neck holding • Prone to supine and
Supine to prone
• FM:grasp disappear Mouthing ,drops when
other object is given

• LING:Cooing Monosyllable

• SOC:Recognise Mirror play

mother
• 9 mon • 24 mon
• GM:Crawling • Runs ,2 foot per steps
• FM:pincer grasp • 6 cubes,vertical
• L:bisyllable strikes,turns1 page
• S:bye bye ,clap • Simple sentences
• Dry by day
• 12 mon
• Walk independently • 3 yrs
• Casting • Tricycle ,1 foot up per
appears+Mouthing step
disappear • 9 cubes ,handedness
• 2 words with meaning • Knows name,sex,age
• Wave hand to NO • Dry by night
• 4 yrs • 5 yrs
• Hops/jumps,1 foot • Skips
down per step • Draws
• +, • Colors, simple additions
• Dress and undress
• Stories ,poems without assistance
• Toilet alone

RULE OF THUMB:
Social smile by 2 mon
head control by 4 mon
sitting by 8 mon
standing by 12 mon
+child sees,hears ,listens normally
• IQ : MENTAL AGE * 100
CHRONOLOGICAL AGE

DQ: DEVELOPMENTAL AGE *100

CHRONOLOGICAL AGE

CLASSIFICATION OF MILESTONES:
Normal
Delayed –motor/speech/mental/bowel
bladder/global
Neuroregression
• Mental retardation(Intellectual disability)
defined as subaverage general intelligence
manifesting during early developmental period
where child has diminished learning capacity and
do not adjust well socially.
--grading based on
Perception,recognition,memory,conceptualisatio
n,motor competence etc
--Based on IQ , MR is classified into following
degrees: mild
moderate
severe
profound
Severity of MR IQ LEVEL

• MILD 51-70 EDUCABLE

• MODERATE 36-50 TRAINABLE

• SEVERE 21-35
CUSTODIAN
• PROFOUND 0-20
• ETIOLOGY
• Chromosomal disorders: Trisomies 21, 18, 13; Klinefelter
syndrome
• Genetic syndromes: Fragile X, Prader-Willi syndrome, tuberous
sclerosis
• Inborn errors of metabolism: Phenylketonuria, Tay-Sachs
disease, mucopolysac charidoses, galactosemia, organic
acidemias
• Congenital infections: HIV, toxoplasmosis, rubella, CMV,
syphilis, herpes simplex
• Perinatal causes: Hypoxic ischemic encephalopathy, intraventricular
hemorrhage, periventricular leukomalacia, fetal
alcohol syndrome
• Postnatal causes: Trauma, meningitis, hypo glycemia,
kernicterus, thrombosis of cerebral vessels
• Iodine deficiency
• Developmental defects: Microcephaly, craniostenosis, porencephaly,
cerebral migration defects
• PREDISPOSING FACTORS:-
-Low socioeconomic status:
inadequate mother and child nutrition,
poor antenatal and obsteitric care
lack of immunisation
delayed and Inappropriate trmt of infections
-LOW BIRTH WEIGHT
-Advanced maternal age
-Consanguinity
CLINICAL FEATURES:
*cerebral dysfunction:hyperactivity,
- short attention span(distractibility-poor
concentration)
- poor memory
-impulsiveness,awkward clumpsy movements
-disturbed sleep
-Emotional instability,frustration,low tolerance
*assoc visioan,speeech,hearing often found in
congenital anomalies,neurological systm defects
*CONVULSIONS are commom in mentally
handicapped
• Thorough history taking incl
developmental,family history
• Complete physical exam’n +fundus exam’n
• Additional investigations to rule out
etiological causes like-
*urine tests=phenylketonuria,homocysteinuria
*chromosomal studies
*tests to Dx Hypothyroidism,storage disorders
*CT,MRI to rule out hydrocephalus,cranial
migration defects
• PREVENTION
• Genetic counsellling-consanguinous marriage,>35
old mothers screened for downs
• Vaccination against rubella in girls
• Good antenatal care,avoidance of
teratogens,chromosomal studies,amniocentesis etc
• Postnatally preventing neonatal infections ,early
detection and treatment,(hyperbilirubinemia Rx
phototherapy/exchange tranfusion, hypothyroidism)
• TREaTMENT
• Parental couselling together and educating them by
minimal criticism,high appreciation,short term goal
achievement
• Avoiding institutionalisation
• Treament of epilepsy ,visual disturbances,speech
therapy,hearing impairment
• Drug therapy
• Special education
• In extreme cases-nursing and nutritional
management may be required
• Q:Individuals with downs syndrome often
have moderate to severe intellectual disability
with measurable IQ between
• A)45-50
• B)55-60
• C)35-55
• D)25-35
• Q: Which of the following is the main
neurological birth syndrome caused by
anoxia?
• a)Down Syndrome
• b)Fragile X syndrome
• c)Cerebral palsy
• d)Cerebral Vascular accident
• Q:Which of the following is a form of child
abuse that is known to cause intellectual
disability?
• a)Shaken baby syndrome
• b)Abused child syndrome
• c)Battered baby syndrome
• d)Damaged infant syndrome
• Q: Which of the following procedures can be
used to identify Down Syndrome pre-natally?
• a)Amniocentesis
• b)Amnioprolaxis
• c)Amniophalaxi
• d)Amniocalesis
Q:Treatable cause of MR is

A)Hypothyroidism
B)Mucopolysaccharidosis
C)Turner's syndrome
D)Down's syndrome;
• Q:Lack of development of speech in a child
can be due to?

A)Tongue tie
• B)Deafness & Mental subnormality
• C)laryngomalacia
• D)Psychosocial