Introduction:

 INTRODUCTION:
 In general, mentally retarded children reach such developmental
milestones as walking and talking later much the than children in the
general population.
 Symptoms of mental retardation may appear at birth or later in
childhood.
 Some cases of mild mental retardation are not diagnosed before the
child enters preschool or kindergarten.
 These children typically have difficulties with social,
communication and functional academic skills.
 Children who have a neurological disorder or illness such as
encephalitis or meningitis may suddenly show signs of cognitive
impairment and adaptive difficulties
Definition :

Mental retardation (MR) is defined as a level of

intellectual functioning (as measured by standard
intelligence tests) that is well below average and results
in significant limitations in the person's daily living skills
(adaptive functioning).

-American Association on Mental Retardation (AAMR).

 Definition

• Mental retardation is defined as an IQ score below 70-75. Adaptive

skills is a term that refers to skills needed for daily life and such
skills include the ability to produce and understand language
(communication); home-living skills: use of community resources;
health, safety, leisure, self-care, social skills; self-direction
functional academic skills (reading, writing, and arithmetic): and
job-related skills.
• Intellectual functioning level is defined by standardized tests that
measure the ability to reason in terms of mental age (intelligence
quotient or IQ).
 Epidemiology
• The survey of Mental Retardation in Nepal
(1989) estimated 4.9 % of the total
population had learning difficulties.
 Diagnostic criteria
• Significantly sub-average intellectual
functioning: an IQ score of approximately 70
or below
• Concurrent deficits or impairments in present
adaptive functioning

• The onset is before age 18 years

 Causes of mental retardation
• Majority of cases are idiopathic.
• Known causes are categorized under blowing headings:

 Prenatal factors:
 Metabolic disorders such as galactosemia (deficiency of galactose
metabolism),
 Chromosomal disorders (common Down's syndrome, Klinefelter
syndrome.
 Environment and nutritional defect: iodine deficiency,
 Neuroectodermal dysplasia e.g. tuberous sclerosis.
 Developmental defect such as Microcephaly.
 Natal factors:
 Birth injuries, ischemia and encephalopathy, intracranial
hemorrhage, prematurity and low birth weight.
 Postnatal factors:
 Infection of central nervous system, malnutrition, head
injury, hypoxia, hypoglycemia, kernicterus, autism, and
child abuse.
 Maternal factors:
 Use of teratogenic drugs, infection such as rubella,
toxoplasmosis, cytomegalovirus , herpes, syphilis and HIV
during pregnancy, placental insufficiency, antepartum
hemorrhage and radiation exposure during pregnancy.

 Family history of mental retardation.

 CLASSIFICATION:

The Diagnostic and Statistical Manual of Mental Disorders,

fourth edition, text revision (DSM-IV-TR), which diagnostic
standard for mental healthcare professionals in the United
States, classifies four different degrees of mental retardation-
mild, moderate severe, and profound. These categories are
based on the person's level of functioning.

According to Wechsler's scale the classification of mental

retardation as follows:
1.Mild Mental Retardation:
 Approximately 85% of the mentally retarded population is in the mildly
retarded category.
 Their IQ score ranges from 55 to 69, and 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 with community and social support.

2. Moderate Mental Retardation

 About 10% of the mentally retarded population is considered
moderately retarded.
 Moderately retarded persons have IQ scores ranging from 25 to 39.
 They can carry out work and self-care tasks with moderate
supervision.
 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,
 3.Severe Mental Retardation :
 About 3%-4% of the mentally retarded population is severely retarded.
 Severely retarded persons have IQ scores of 20-40.
 They may master very basic self-care skills and some communication
skills.
 Many severely retarded individuals are able to live in a group home.

 4. Profound Mental Retardation :

 Only 1%-2% of the mentally retarded population is classified as
profoundly retarded.
 Profoundly retarded individuals have IQ scores under 0-24.
 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
supervision.
 Clinical features
• Newborn
– Dysmorphisms
– Major organ system dysfunction (e.g., feeding and breathing)
• Early infancy (2-4 mo)
– Failure to interact with the environment
– Concerns about vision and hearing impairments
• Later infancy (6-18 mo)
– Gross motor delay
• Toddlers (2-3 yr)
– Language delays or difficulties
• Preschool (3-5 yr)
– Language difficulties or delays
– Behavior difficulties, including play
– Delays in fine motor skills: cutting, coloring, drawing
• School age (over 5 yr)
– Academic underachievement
– Behavior difficulties (attention, anxiety, mood, conduct, and so
on)
 Clinical features
• Behavior problems: Symptoms like
restlessness (continuously moving around; unable to
sit in one place), poor concentration, impulsiveness,
temper tantrums, irritability and crying are common
• Convulsions: About 25% of people with mental
retardation get convulsions
• Sensory impairments: Difficulties in seeing
and hearing are present in about 5-10% of persons
with mental retardation
 DIAGNOSIS
1. History: Prenatal, natal, postnatal, family history
developmental history and history related to behavior
disorders of children.
2. Physical examination: Look for head size, hair, skin (cafe
lait spots, pigmented whorls, eczema, and dryness),
eye(cataracts, cherry red spot, and dislocated lens faces,
hearing defect, hepatomegaly and short stature.
3. Investigations includes: Blood, urine, thyroid function test.
chromosomal analysis and metabolic screening.
4. CT Scan of brain to rule out underlying causes. :
 Management
• Early diagnosis is Important
• Importance of developmental milestone
• Do not ignore parental concerns and
observations
• Monitoring of high risk newborns for first 2
years
• Developmental screening tests
 Management
• 1.Parental counseling: Consider the important aspects of
parental counseling that includes:
 Breaking news in a phased manner in presence of both
parents.
 Avoid using offending terms during counseling such as good
for nothing.
 Positive aspects of the disease should be discussed followed
by the problems without withholding the truth.
 Ensure full participation of family members in management.
 Try to remove guilt and myths form the parents mind.
 Regular screened of child for further handicap.
 Treatment of underlying causes.
 Physiotherapy as per child's need.

Prevention:
• Primary prevention should focus on iodine supplementation,
adequate nutrition, prevention of anemia ,avoidance of toxins
(lead), avoid consanguinity and avoid very young and very
old pregnancy, preconception folic acid, good antenatal,
intrauterine and perinatal care, screening for intrauterine
infections and prenatal screening.
• Secondary prevention should focus on genetic counseling
prenatal diagnosis, early diagnosis and treatment. Tertiary
prevention should focus on early rehabilitative actions as well
as support system.
 Management
• Medications
– Associated behavioral and psychiatric
disorders only
Nursing Care:
1. Educate the child using effective teaching strategies.
2. Teach the child self-care skills such as feeding dressing toileting etc.
3. Promote the child's optimum development through; Play, communication,
discipline, socialization, nutrition and immunization.
4. Help the family adjust to future care:
 Family need to understand the child limitation..
 Refer child to rehabilitation center if needed.
 Care during hospitalization and physical illness.
 Thought community about the condition of the child so the they can also
help the child.
5.Provide special care for the child during hospitalization
 Some Do's and Don'ts for parents…
• Look at abilities rather than disabilities in the child.
• Notice successes and praise them, however small these may
be.
• Try to learn the techniques of training and practice them.
• Remember that those with mental retardation are slow in
learning but they can still be taught with patience, persistence,
and the correct approach.
• Find out about services that are available and utilize them.
• There is no need to feel ashamed about having a retarded
child.
• There is no need to blame oneself or other family members
for the child's condition.
• Do not overprotect the child; as far as possible encourage
them to stand on their own feet.
• Do not waste money unnecessarily on dubious treatments,
which have not been proven.
•