1. Mental Retardation (MR) Dr Shreedhar Paudel May, 2009

2. MR…… Mental retardation is a developmental disability marked by lower-than-normal intelligence and limited daily living skills Diminished learning capacity and does not adjust well socially Mental retardation is normally present at birth or develops early in life

3. MR…. Mental retardation is defined by two standards – first standard is a person's level of intelligence usually measured by special tests called intelligence tests – Intelligence tests provide a numerical ranking of a person's mental abilities called an intelligence quotient or, more commonly, an IQ

4. MR…. The second standard for mental retardation is adaptive skills – means how well a person can deal with the tasks of everyday life the ability to speak and understand home-living skills use of community resources leisure, self-care, and social skills basic academic skills (reading, writing, and arithmetic); and work skills

5. MR…. Intelligence Quotient:- – Mental age divided by chronological age multiplied by 100 – Degrees of mental handicap Mild→ 51--70 Moderate→ 36--50 Severe→ 21--35 Profound → 0--20

6. MR… I.Q level 71—90 → borderline intelligence (not included in mental handicap) Mild and moderate are educable and trainable Severe and profound are custodian

7. MR… Mild Mental Retardation – 85 percent of the mentally retarded population – Individuals often live on their own with community support Moderate Mental Retardation – 10 percent of the mentally retarded population – Individuals often lead relatively normal lives provided they receive some level of supervision – Often live in group homes with other mentally retarded people

8. MR… Severe Mental Retardation – 3% to 4% of the mentally retarded population – master the most basic skills of living, such as cleaning and dressing themselves – often live in group homes Profound Mental Retardation – 1 % to 2% of the mentally retarded population – develop basic communication and self-care skills – often have other mental disorders

9. MR…. Etiology:- – Interplay of several biomedical, sociocultural and psychological factors – Prenatal Metabolic –galactosemia, mucopolysaccharidosis Chromosomal – Down’s synd., Klinefelter syndrome Maternal factor – teratogenic drugs, infection during pregnancy Neuroectodermal – tuberous sclerosis Iodine deficiency

10. MR…. Natal – Birth injury – Hypoxic ischemic encephalopathy – Hemorrhage Post natal – Infection – Head injuries – Hypoxia – Thrombosis of cerebral vessels – Kernicterus – Malnutrition – Child abuse

11. MR… Predisposing factors – Low socioeconomic status – Low Birth Weight (LBW) – Advance maternal age – Consanguinity

12. MR…. Symptoms – Continued infantile behavior – Decreased learning ability – Failure to meet intellectual developmental markers – Inability to meet educational demands at school – Lack of curiosity – Etiological presentation

13. MR… Changes to normal behaviors depend on the severity of the condition Mild retardation may be associated with a lack of curiosity and quiet behavior Severe mental retardation is associated with infantile behavior throughout life

14. MR… Investigations:- – Urine tests :- for metabolic diseases – TFT :- T3, T4, TSH – Genetic studies :- chromosomal studies – Serology for TORCH – LP :- any CNS infections – CT and MRI :- hydrocephalus, absence of corpus callosum, tuberous sclerosis

15. MR… Exams and Tests – Abnormal Denver developmental screening test – Adaptive behavior score below average – Development below that of peers – Intelligence quotient (IQ) score below 70 on a standardized IQ test

16. MR… Other Scales – Wechsler preschool and primary scale of intelligence(WPPSI) – Wechsler intelligence scale for children (WISC) – Stanford Biner Test (SBT) – Denver ii development screening test

17. MR… Treatment – The primary goal of treatment is to develop the person's potential to the fullest – Special education and training may begin as early as infancy – This includes social skills to help the person function as normally as possible

18. MR… Treatment – It is important for a specialist to evaluate the person for other affective disorders and treat those disorders – Behavioral approaches are important for people with mental retardation – Parents should be counseled together

19. MR….. Treatment – Anticonvulsive treatment is prescribed for seizures but phenobarbitone should be avoided – Hyperactivity treated with Amphetamine – Psychologically – warmth, love and appreciation