MENTAL RETARDATION

CLASSIFICATION OF
CHILDHOOD DISORDERS
F70-F79 F79 MENTAL
RETARDATION
 F70 MILD MENTAL RETARDATION
 F71 MODERATE RETARDATION
 F72 SEVERE MENTAL RETARDATION
 F73 PROFOUND MENTAL RETARDATION

F80-F89 DISORDERS OF
PSYCHOLOGICAL DVELOPMENT
 F80 specific development disorders of speech and
language
 F81 specific developmental disorders of scholastic
skills
 F82 specific developmental disorders of motor function
 F83 mixed specific developmental disorders
 F84 pervasive developmental disorders

F90-F98 BEHAVIORAL AND EMOTIONAL
DISORDERS WITH ONSET USUALLY OCCURRING IN
CHILDHOOD AND ADOLESCENCE
 F90 hyperkinetic disorders
 F91 conduct disorders
 F93 emotional disorders with onset specific to
childhood
 F94 Disorders of social functioning with onset
specific to childhood &adolescence

DEFINITION
“Mental retardation refers to
significantly subaverage general
intellectual functioning resulting in or
associated with concurrent
impairments in adaptive behavior &
manifested during the developmental
period”

 General intellectual functioning is defined as the
result obtained by the administration of
standardized general intelligence tests developed
for the purpose, & adopted to the conditions of
the region/country.
 Significant subaverage is defined as an
Intelligence Quotient (IQ) of 70 or below on
standardized measures of intelligence. The upper
limit is intended as a guideline & could be
extended to 75 or more, depending on the
reliability of the intelligence test used.

 Adaptive behavior is defined as the degrees with which
the individual meets the standards of personal
independence & social responsibility expected of his age
& cultural group. The expectations of adaptive behavior
vary with the chronological age. The deficits in adaptive
behavior may be reflected in the following areas:
 During infancy & childhood
 Sensory & motor skill development
 Communication skill (including speech & language)
 Self help skills
 Socialization

 During childhood & adolescence
 Application of basic academic skill to daily life
activities
 Application of appropriate reasoning & judgment in the
mastery of the environment
 Social skills.
 During late adolescence
 Vocational & social responsibilities & performance
Developmental periods is defined as the period of time
between conception & the 18th birthday.

EPIDEMIOLOGY
 About 3% of the world population is estimated to be
mentally retarded.
 In India, 5 out of 1000 children are mentally retarded
(The Indian Express, 13th March 2001).
 Mental retardation is more common in boys than
girls.
 With severe & profound mental retardation mortality
is high due to associated physical disease.

ETIOLOGY
 Genetic Factors
 Chromosomal
abnormalities
Down’s syndromes
Fragile X syndrome
Trisomy X syndrome
Turner’s syndrome
Cat-cry syndrome
Prader-willi syndrome
 Metabolic disorders
Phenylketonuria
Wilson’s disease
 Galactosemia
 Cranial malformation
Hydrocephaly
Microcephaly
 Gross disease of
brain
Tuberous scleroses
Neurofibromatosis
Epilepsy

 Prenatal Factors
 Infection
Rubella
Cytomegalovirus
Syphilis
Toxoplasmosis, herpes
simplex
 Endocrine disorders
Hypothyroidism
Hypoparathyrodism
Diabetes mellitus
 Physical damage &
disorders
Injury
Hypoxia
Radiation
Hypertension
Anemia
Emphysema
 Intoxication
Lead & certain drug
Substance abuse
 Placental dysfunction
Toxemia of pregnancy
Placenta previa
Cord prolapse
Nutrition growth
retardation

 Perinatal Factors
 Birth asphyxia
 Prolonged or difficult birth
 Prematurity (due
to complications)
 Kernicterus
 Instrumental delivery
(resulting in head injury,
intraventricular hemorrhage)
 Postnatal Factors
 Infections
 Encephalitis
Measels
Meningitis
Septicemia
 Accidents
 Lead poisoning
Environmental & socio-
cultural Factors
Cultural deprivation
Low socio-economic
status
Inadequate caretakers
Child abuse

IQ
 Intelligent quotient (IQ) is the ratio between Mental Age
(MA) and Chronological Age (CA).
MA
IQ= --------- × 100
CA
 Chronological age is determined by date of birth,
 Mental age is determined by intelligence tests.

CLASSIFICATION OF MR
 Mild Retardation (IQ 50-70)
This is commonest type of mental
retardation accounting for 85-90% of all cases. These
individuals have minimum retardation in sensory-
motor areas.
 Moderate Retardation (IQ 35-50)
About 10% of mentally retarded come
under this group.

Count… Severe Retardation (IQ 20-35):
Severe mental retardation is often recognized
early in life with poor motor development &
absent or markedly delayed speech &
communication skills.
 Profound Retardation (IQ below 20):
This group accounts for 1- 2% of all mentally
retarded. The achievement of developmental
milestones is markedly delayed.
They require constant nursing care and
supervision.

SIGN AND SYMPTOMS
 Psychomotor skill
deficits
 Difficulty performing
self-esteem
 Irritability when
frustrated or upset
 Depression or labile
moods
 Acting-out behavior
 Persistence of infantile
 Failure to achieve
developmental
milestones
 Deficiency in cognitive
functioning such as inability
to follow commands or
directions
 Failure to achieve intellectual
developmental markers
 Reduced ability to learn or to
meet academic demands
 Expressive or receptive
behavior

DIAGNOSIS
 History collection from parents & caretakers
 Physical examination
 Neurological examination
 Assessing milestones development
 Investigations
– Urine & blood examination for metabolic disorders
– Culture for cytogenic & biochemical studies
– Amniocentesis in infant chromosomal disorders
– chorionic villi sampling
– Hearing & speech evaluation

Count…
 EEG, especially if seizure are present
 CT scan or MRI brain, for example, in
tuberous sclerosis
 Thyroid function tests when cretinism is
suspected
 Psychological tests like Stanford Binet
Intelligence Scale & Wechsler Intelligence
Scale for Children’s (WISC), for categorizing
the child’s level of disability.

PROGNOSIS
 The prognosis for children with mental retardation
has improved & institutional care is no longer
recommended.
 These children are mainstreamed whenever
feasible & are taught survival skills.
 A multidimensional orientation is used when
working with these children, considering their
psychological, cognitive, social & emotional
development.

TREATMENT MODALITIES
 Behavior management
 Environmental supervision
 Monitoring the child’s development needs & problems.
 Programs that maximize speech, language, cognitive,
psychomotor, social, self-care, & occupational skills.
 Ongoing evaluation for overlapping psychiatric disorders,
such as depression, bipolar disorder, & ADHD.
 Family therapy to help parents develop coping skills & deal
with guilt or anger.
 Early intervention programs for children younger than 3
with mental retardation
Provide day schools to train the child in basic skills, such
as
bathing & feeding.
Vocational training.

NURSING PROCESS:
ASSESSMENT:
 Nurses should assess and focus on each
client’s strengths and individual abilities.
 Knowledge regarding level of independence in
the performance of self-care activities is
essential to the development of an adequate
plan for the provision of nursing care.

NURSING DIAGNOSIS:
 Risk for injury related to altered physical mobility or
aggressive behavior.
 Self-care deficit related to altered physical mobility
or lack of maturity.
 Impaired verbal communication related to
developmental alteration.
 Impaired social interaction related to speech
deficiencies or difficulty conforming to conventional
social behavior.

Conti..
 Delayed growth and development related to isolation from
significant others; inadequate environmental stimulation;
hereditary factors.
 Anxiety (moderate to severe) related to hospitalization and
absence of familiar surroundings.
 Defensive coping related to feelings of powerlessness and
threat to self-esteem.
 Ineffective coping related to inadequate coping skills
secondary to developmental delay.

PREVENTION:
Primary prevention
 Preconception:
Genetic counsellling
Immunization for
maternal rubella
Blood test to identify
presence of veneral
diseases
Adequate maternal
nutrition
Family planning
 During gestation:
Prenatal care
Adequate nutrition
Analysis of fetus for
possible genetic disorders
 At delivery: should be
conducted by experts, apgar
scoring
 Childhood: proper nutrition,
avoidance of hazards,
prevention of accidents

CONTI….
Secondary Prevention
Early detection &
treatment
Early recognition of
presence of MR
Psychiatric treatment
for emotional and
behvaiour difficulties
Tertiary Prevention
Rehabilitation in
vocational, physical &
social areas.
Rehabilitation aimed
at reducing disability
and providing optimal
functioning in a child
with MR.

CARE AND REHABILITATION OF
THE MENTALLY RETARDED
 The main elements in a comprehensive service for mentally
retarded individuals and their families include:
 The prevention and early detection of mental handicaps.
 Regular assessment of the mentally retarded person's attainments
and disabilities.
 Advice, support, and practical measures for families
 Provision for education, training, occupation, or work appropriate
for each handicapped person.
 Housing and social support to enable self- care.
 Medical, nursing, and other services for those who require them as
outpatients, day patients, or inpatients.
 Psychiatric and psychological services.

CONT…
 General provisions: General approach to care is educational and psychosocial.
 Pediatrician and family doctor responsible for early detection and assessment of
MR.
 The mildly retarded:
This children require fostering, boarding schools placements or residential care, but usually
sepcialist services are not required.
This adults may need help with housing, employement or with the sepcial problmes of old age.
 The severely retarded:
They required special services include a sitting service, overnight stays in a foster
family or residential care.
Provisions required for work, occupation, housing, adult education etc.
 Education and training:
 Use of specialist teaching and variety of innovative procedures for teaching
language and other methods of communication. Before leaving school, these
children require reassessment and vocational guidance.

Hints for Successful Skill Training
 Divide each training activity into small steps and
demonstrate.
 Give the mentally retarded person repeated training in
each activity
 Give the training regularly and systematically. Do not
let parents impatient.
 Start the training with what the child already knows
and then proceed to the skill that needs to be trained.
By this the child will have a feeling of success and
achievement.
 Reward his effort even if the child attains near success,
by appreciation or with something what he likes.

CONT…
 Reduce the reward gradually as he masters a skill and takes up another
skill for training
 Use the training materials which are appropriate, attractive and locally
available.
 Remember, children learn better from children of the same age.
Therefore try and involve normal children of the same age in training
the mentally retarded child, after orienting the normal child
appropriately.
 Remember there is no age limit for training a mentally retarded person.
 Assist the child periodically, preferably once in four and six months.
 Remember a mentally retarded child learns very slowly tell the parents
not to be dejected at the slow progress, nor feel threaten by child’s
failure

CONT…
 Vocational Training: activities included are work preparation, selective
placement, post placement and follow up.
 Help for families
 Stages in parent counseling:
 Stage 1: Impart information regarding condition of the mentally retarded
child. Avoid giving misleading information or building false hopes in the
parents.
 Stage 2: Help the parents develop right attitude towards their mentally
retarded child (to prevent overprotection, rejection, pushing the child too
hard). Handle guilty feeling in parents.
 Stage 3: Create awareness in parents regarding their role in training the child.
The parents should be made to realize that training a mentally retarded child
does not need complex skills and with repeated training in simple steps, the
child can learn.

CONT…
 Residential care: Parents should be supported in caring
for their retarded children at home, or if they are too
heavy a burden for their parents, the child should be
cared for in day care centers, halfway homes, etc.
 Specialist medical services: Retarded children and
adults often have physical handicaps or epilepsy for
which continuing medical care is needed.
 Psychiatric services: Expert psychiatric care is an
essential part of a comprehensive community service
for the mentally retarded.

You can refer following link also
 https://www.youtube.com/watch?v=poxEYM0
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