Mental Retardation

The term “mentally handicap” is now used for the conduction “mental retardation”.

At least 2 to 3 % of Indian population are mentally handicapped in any form.
Mental handicapped is the significantly sub average general intellectual functioning existing concurrently with deficits in adaptive behavior manifested during the developmental period.

It includes the learning disability, poor maturation and social mal adjustment in combination.

1. MentalRetardation
By
Mr. Ravi Rai Dangi
Assistant Professor
MSc. Child Health Nursing

2. Mentally challenged
Theterm“mentallyhandicap”isnowusedforthe
conduction“mentalretardation”.
Atleast2to3%ofIndianpopulationarementally
handicappedinanyform.

3. Mentalhandicappedisthesignificantlysubaverage
generalintellectualfunctioningexistingconcurrentlywith
deficitsinadaptivebehaviormanifestedduringthe
developmentalperiod.
Itincludesthelearningdisability,poormaturationand
socialmaladjustmentincombination.

4. Cause/Etiology of Handicap
Perinatalfactors
Birthasphyxia
Prolongedanddifficultbirth
Prematurity
Kernicterus
Instrumentaldeliveryresultinginheadinjury

5. Geneticfactors
Geneticmutation
Geneticincompatibilitiesbetweenparents
Chromosomaldisorders

6. Placentaldysfunction
Toxemiaofpregnancy
PlacentaPrevia
Cordprolapse
Nutritionalgrowthretardation

7. Postnatalfactors
CNSInfections(encephalitis,meningitis,
septicemia,measles)
Accidents
Iodinedeficiency
SeverePEM
Metabolicdisorder

8. Environmentalandsocialfactors
Poverty
Brokenfamily
Faultyparenting
Childabuseandneglecting
Parentalpsychopathology
Environmentaldeprivation

9. Classification
Mildmentalretardation
Approximately85%ofthementallyretarded
populationisinthemildlyretardedcategory.TheirIQscore
rangesfrom51-70,andtheycanoftenacquireacademic
skillsuptoaboutthesixth-gradelevel.
Theycanbecomefairlyself-sufficientandinsome
casesliveindependently,withcommunityandsocial
support.

10. Moderatementalretardation
About10%ofthementallyretardedpopulationis
consideredmoderatelyretarded.Moderatelyretarded
personshaveIQscoresrangingfrom36-50.Theycan
carryoutworkandself-caretaskswithmoderate
supervision.
Theytypicallyacquirecommunicationskillsinchildhood
andareabletoliveandfunctionsuccessfullywithinthe
communityinsuchsupervisedenvironmentsasgroup
homes

11. Severementalretardation
About3-4%ofthementallyretardedpopulationis
severelyretarded.SeverelyretardedpersonshaveIQ
scoresof20-35.
Theymaymasterverybasicself-careskillsandsome
communicationskills.Manyseverelyretarded
individualsareabletoliveinagrouphome.

12. Profoundmentalretardation
Only1-2%ofthementallyretardedpopulationis
classifiedasprofoundlyretarded.Profoundlyretarded
individualshaveIQscoreunder20.
Theymaybeabletodevelopbasicself-careand
communicationskillswithappropriatesupportand
training.
Theirretardationisoftencausedbyanaccompanying
neurologicaldisorder.Profoundlyretardedpeopleneeda
high-levelofstructureandsupervision.

13. CLINICAL SIGN AND SYMPTOMS
Ininfancy
Thechildmanifestedwithpoorfeeding,weak
un-coordinatedsucking,leadingtopoorweightgain,
delayedordecreasedvisualalertnessandauditoryrepose,
reducespontaneousactivitydelayedheadandtrunkcontrol,
hypotonicorspasticmuscletoneandpoormotherchild
interaction.

14. InToddler
Thepresentationisdelayedspeechandlanguage
disabilities,delayedmotormilestone(standingand
walking),failuretoachieveindependence(likeself-
feeding,dressing,toilettraining),shortattentionspanand
distractively,clumsiness,hyperactivity,poormemory,
poorconcentration,emotionalinstability,sleepproblems,
impressivenessandlowfrustrationtolerance.
Convulsion
Muscularskeletondefect
Visionandhearingdefect
Psychiatricillness

15. Emotionalproblems
Cretinism
Meucopolysaccharidosis
Neurodegenerativedisorder

16. Diagnostic evaluation
Detailedhistoryofdevelopmentalperiod

17. Family history
Any illness
history
Similar
history in
family
Consanguineous
marriage

18. Birth history
CIAB
Type of
Delivery
Labour time

21. Management

22. Adequatediagnosticfacilitiestodetectassociated
problemsandappropriatemanagementofthespecific
conditionshouldbearranged.
Familymembersandparentsneedcounselingregarding
variousaspectsoftheconditionandnecessary
management.

23. Parentsshouldbeexplained,informedanddiscussed
aboutthelongtermcareathomesituationaccordingto
thechild’sIQlevelandassociatedproblems
Importancetobegivenonpromotionofself-careability
andindependenceofthechild

25. Necessarydrugtherapyshouldbediscussedwith
parents
Psychologicalandemotionalsupportneededfor
parentsandfamilymembers.
Thechildneedslove,affection,appreciation,discipline
andminimalcriticismfortenderlovingcarefrom
parentsandfamilymembers.

26. Thechildmaybesendtodaycarecenterorspecial
schoolorvocationalcentersorworkshop.
Thechildneedssupporttodeveloppotentialstothe
maximumandtobecomeindependentaspossiblefor
self-help.
Specialeducationalarrangementandavailablefacilities
shouldbediscussedwiththeparents.