Mental Retardation (SYN. Learning Disabilities, Intellectual Impairment) Psychiatry

Mental Retardation is below average general intellectual functioning originating during the development period and associated with Impairment in Adaptive Behaviour.

- Arrested or Incomplete Development of Mind
- Subnormal State of Intelligence
- It is not an illness, but a condition of poor development of brain.

Age before 18 years
- 1 to 2 % of General Population
- Growth & Development is Slow
- Associated Conditions like Fits, Hearing Problem, Visual Problem or Physically Handicap or Behavioural Problems.
- When the Mental age lesser than the Physical Age, Such child is considered Mentally Retarded.

Intelligence of a person is referred as Intelligence Quotient

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Formula: IQ = (Mental Age/Chronological Age) X 100
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IQ = < 70 – Mental Retardation

Classification – On the Basis of IQ
1. Mild Mental Retardation 50 – 69
2. Moderate Mental Retardation 35 – 49
3. Severe Mental Retardation 20 – 34
4. Profound Mental Retardation Below 20

Based on Practical Classification
1. Educable Group
2. Trainable Group
3. Custodial Group

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Recognition of Mental Retardation in Children
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1. By talking to the parents, especially mother, in detail about the growth of the Child.
2. By observing the child’s physical appearance and behaviour.

Important Mile Stones
3 Months - Holding Neck Erect
6 Months - Sitting with Support
9 Months - 1 Year - Walking
1 – 1½ Years - Speaking few words or phrases
1. Below 5 Years – History of Delayed Milestones
2. Above 5 Years – History of School Failures, Behaviour Problems & Behaviour against society’s expectations.

Physical Appearance
- Small or Large Head
- Slanting Eyes
- Thick Protruding Tongue
- Microcephaly, Hydrocephalus
- Rough SKIN
- Stunted Growth

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Causes of Mental Retardation
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Genetic
- Chromosome Abnormalities
- Down’s Syndrome
- Klinefelter’s Syndrome
- Turner’s Syndrome

Metabolic Disorders Affecting
- Amino Acids (Eg. Phenylketonuria, Homocystinuria, Hartnup Disease)
- The Urea Cycle (Eg. Citrullinuria, Aminosuccinic Aciduria)
- Lipids (Tay-Sach’s, Gaucher’s & Niemann-Pick Diseases)
- Carbohydrate (Lesch-Nyhan Syndrome)
- Mucopolysaccaharidoses (Hurler’s, Hunter’s, Sanfilippo’s )

Gross Disease of the brain
- Tuberous Sclerosis
- Neurofibromatosis
- Cranial Malformations
- Hydrocephalus
- Microcephalus

Antenatal Damage
- Infections (Rubella, Cytomegalo Virus, Syphilis)
- Intoxications (Lead, Alcohol)
- Physical Damage (Injury, Radiation)
- Placental Dysfunction (Toxaemia, Nutritional Growth Retardation)
- Endocrine Disorders (Hypothyroidism, Hypoparathyroidism)

Perinatal
- Birth Asphyxia
- Complications of Prematurity
- Kernicterus
- Intraventricular Haemorrhage Post-Natal Damage
- Injury (Accidental, Child Abuse)
- Lead Intoxication
- Infection (Encephalitis, Meningitis)
- Malnutrition

Common Causes of Mental Retardation in India

1. Infection during Infant – Encephalities Meningitis
2. Infection during pregnancy – Rubella, Syphilis, AIDS
3. Nutritional Deficiency during Pregnancy and Childhood
4. Primary & Genetically related Causes
5. Chromosomal Abnormality – Downs Syndrome
6. Endocrine – Cretinism
7. Phenylketonuria

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Rehabilitation & Nursing Care
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Rehabilitation
- Depends upon their disability
- Assesses through IQ & Clinical Evaluation

Problem – Three Aspects
1. Impairment – brain Injury
2. Disability – Reading Arithmetic
3. Social Handicap – Occupation or Personal Relationship

Assessment
- Whether the condition is treatable and reversible

Education of Mentally Retarded Children
- Mild and Moderate Mentally Retarded
- Education Program in a Special School
- Specially trained Teachers

Training the Mentally Retarded
- Mild & Moderate Mental Retardation
- Special Training
- Sheltered Workshop – Gardening, Book Binding, Paper & Cover Making
- Specially trained teachers with Occupational Therapists

Custodial Care
- Severe or profound mentally retarded
- Either at home or in the institutions like Special Center or Hospital.

Indication for Institutional Care
1. Severe Mentally Retarded without any Social Support
2. Severe Mentally Retarded with Behavioural Problems
3. Severe Mental Retarded with Complications like intractable epilepsy
4. Short Time stay for Family Members [like Function Time]

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Prevention of Mental Retardation Before Conceiving (for mothers)
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# Rubella Immunisation
# Genetic Counselling
# Health Education – Diet, Smoking & Alcohol abstinent.
# Consanguinous Marriages
# Prenatal
# Identification of Risk /groups
# Rubella Screening
# Syphilis & Aids Screening
# Ultrasound Scan
- Microcephalus
- Hydrocephalus
- Multiple Births
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Prevention of Mental Retardation
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Natal
# Improved obstetric & Natal Care
Postnatal
# Neonatal Screening of treatment of Hypothyroidism
# Immunisation – Encephalitis & Meningitis
# Reduce Child abuse, Road Traffic Accident & Home Accident
# Health Education

Mental Retardation cannot be cured, but can be improved through proper care. Mental Retardation improved with training but slowly. Require Good Food, Love & Affection, Special Education & Training, Good Social Support, Controlling systemic infections and Parent’s Counselling

Note: Author: Dr. M. RAJARAM

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