MENTAL RETARDATION

INTRODUCTION
Mental retardation = learning diasability Definition : irreversible impairment in intellectual originating early in life. Associated with social functioning limitation

DIVISION
Divided into 4 subgroups : 1) 2) 3) 4) Mild ( IQ : 50 70 ) Moderate ( IQ : 35 49 ) Severe ( IQ : 24 34 ) Profound ( IQ : <20 )

EPIDEMIOLOGY
2 3% of population has an IQ <70 but

Only 1% of general population are MR Gender, M : F = 1.5 : 1

EPIDEMIOLOGY
Based on subgroups :
PERCENTAGE OF MR BASED ON SUBGROUPS
MILD MODERATE SEVERE PROFOUND

1%
7% 12%

80%

AETIOLOGY
Multifactorial : 1) Genetic Downs syndrome - Fragile X - syndrome

In Downs syndrome child : (i) Learning disability varies but mostly IQ 20 50 (ii) Temperanment usually affectionate, easygoing, & interested in music (i) Behaviour problem less frequent

AETIOLOGY
In Fragile X syndrome child : (i) Abnormalities in speech rapid, disorganised, frequent repetition (ii) Social impairment (iii)Disorders of impairment

AETIOLOGY
2) Antenatal problem : (i) Intrauterine infection (ii) Intoxication (iii) Hypothyroidism (iv) physical damage 3) Peri-natal damage : (i)Birth injury (ii) Intraventricular haemorrhage

AETILOGY
4) Post-natal damage : (i) Injury (ii) Infections meningitis (iii)Lead intoxication 5) Social factor : (i) Lower socio-economic status (ii) Unstable family

AETIOLOGY
6) Medical disorders : (i) Hypothyroidism (ii) PKU (iii) iodine deficiency 7) Malnutrition common cause

CLINICAL FEATURES
Mild normal appearance - sensory & motor deficits are slightly - identified late (until child starts school) - in adulthood, can live independently Moderate have enough language development - can learn to take care of themselves under supervision - able to take simple routine work (adult)

CLINICAL FEATURES
Severe slow development ( pre-school & school) - can look after themselves under supervision & special training - can communicate in simple ways - able to undertake simple task & limited social activities (in adulthood) - many have associated physical disorder

CLINICAL FEATURES
Profound few can learn to take care of themselves - few can achieve simple speech & social behavior - physical disorders are very frequent

DIAGNOSIS
1) History taking Family history of inherited disorder Abnormalities in pregnancy or delivery Developmental milestones Any behavior disorder 2) Physical examination Head circumference Height Weight Neurological examination

DIAGNOSIS
3) Behavioral assessment Ability to communicate Sensorimotor skills Unusual behaviour ability to self-care 4) Developmental assessment Intelligence Language Motor performance Social skills

DIAGNOSIS
DSM-IV-TR Diagnostic Criteria for Mental Retardation : A. Significantly subaverage intellectual functioning: an IQ of approximately 70 or below on an individually administered IQ test (for infants, a clinical judgment of significantly subaverage intellectual functioning). B. Concurrent deficits or impairments in present adaptive functioning (i.e., the person's effectiveness in meeting the standards expected for his or her age by his or her cultural group) in at least two of the following areas: communication, self-care, home living, social/interpersonal skills, use of community resources, selfdirection, functional academic skills, work, leisure, health, and safety. C. The onset is before age 18 years. Code based on degree of severity reflecting level of intellectual impairment: 317 Mild Mental Retardation: IQ level 50-55 to approximately 70 318.0 Moderate Mental Retardation: IQ level 35-40 to 50-55 318.1 Severe Mental Retardation: IQ level 20-25 to 35-40 318.2 Profound Mental Retardation: IQ level below 20 or 25

PSYCHIATRIC DISORDERS IN MR CHILD

1)Delirium & dementia 2) Autism 3) Schizophrenia 4) Mood disorder 5) Anxiety disorder 6) Personality disorder 7) Attention deficit hyperactivity disorder 8) Challenging behavior (behavior that threatens the safety of patient / other people)

TREATMENT
Educational *special school/ classes *Counselling & family therapy Psychotherapy * Behavior therapy *Cognitive therapy *Psychodynamic therapy