Mental retardation in pediatric population .ppt

Mental retardation in pediatric population .ppt

1. Lecture by; Doctor Kamila

2. MENTAL RETARDATION
Definition :
Mental Retardation is Characterized by significant
Limitations both in
Intellectual functioning
and in
Adaptive behavior as expressed in conceptual,
social and practical adaptive skills.
“This Disability Originates before the age of 18”

3. INTELLECTUAL FUNCTIONING;

The first Component of the definition is
“Intellectual functioning or Intelligence.”
It is considered to the general mental capability of
an individual,
This capability includes the ability to :
Reason, Plan, Solve Problems, Think Abstractly,
Comprehend complex ideas, Learn quickly and
Learn from experiences.

4. Measure of Intelligence;
• The accepted measure of Intelligence is that
which is determined but an intelligence quotient
(IQ) score, which involves administration of
standardized tests given by a trained Professional.
• In the 1992 publication of American
Association of Mental Retardation (AAMR), a
significant limitation of intellectual functioning
was defined as being equivalent to an IQ score of
approximately 70 or 75 and below.

5. Adaptive Behavior;
As defined by AAMR, “ adaptive
behavior is the collection of
conceptual, social and practical
skills that people have learned so
they can function in their everyday
lives.”
Significant limitations in adaptive behavior
impact a person’s daily life and affect the
ability to respond to a particular situation or
to the environment.

6. Limitations in Adaptive Behavior
•Limitations in adaptive behavior can be
determined by using standardized tests
referenced to the general population,
including people with disabilities.
• On these standardized measures,
significant limitations in adaptive behavior
are operationally defined as performance
that is at least Two Standards below the
mean.

7. Conceptual SkillsSocial Skills Practical Skills
•Receptive and
Expressive language
•Interpersonal
Responsibility
•Personal activities of
daily living, e.g. Eating,
dressing etc.
•Reading and
Writing
•Self esteem •Instrumental activities
of daily living. e.g.
Preparing meals, Using
telephone etc.
•Money Concepts •Gullibility (Likelihood of
being tricked or
manipulated.)
•Occupational skills
•Self Direction •Naivete’ •Maintaining a safe
Environment
•Following Rules
•Obeying laws
•Avoiding victimization

8. ETIOLOGY;
The causes of MR are classified according to ;
• When they occurred in the developmental cycle
i.e; Pre-natally, Para- natally or Post natally.
Or
• By their Origin. i.e; Biomedical Vs.
Enviormental

9. In a large United states population based study
describing probable cause of MR in school age
children, the following results were obtained:
No defined cause -------- 78. 0%
Prenatal conditions -------- 12 . 4%
Genetic ------------ 7. 1 %
Perinatal Conditions ---------- 5. 9 %
Intra-Uterine --------- 5. 2%
Postneonatal event ---------- 3. 6 %
Teratogenic ---------- 2. 9 %
CNS birth defects ----------- 1 . 5 %
Other Birth Defects ---------- 0 . 8 %
Neonatal -------------- 0. 7%

10. Prenatal factors;Prenatal factors;
Prenatal factors that can cause MR include:
i.Genetic Aberrations,
ii.Birth defects that are not genetic in Origin,
iii.Environmental Influences, Or
iv. a Combination of factors .

11. ( i) Genetic Aberrations;( i) Genetic Aberrations;
With Genetic Aberrations the problem is either with the genes
or with the Chromosomes which carry these genes.
 In many cases of MR, the genes or Chromosomes that has
caused the condition can be identified specifically.
 More than 350 inborn errors of metabolism that result from
genetic changes have been identified.
Many of these Disorders lead to MR.
 The two Most Common causes of MR are ;
Down’s syndrome and
Fragile X-Syndrome.

12. ( ii ) Birth Defects ;( ii ) Birth Defects ;
Birth defects that are not considered genetic in origin
also can contribute to / cause MR.
These include ;
 Malformations Of CNS:
Cortical atrophy, Hydrocephaly, Spina Bifida,
Craniostenosis,
Congenital heart anomalies Or
Metabolic disorders not associated with a genetic
defect (hypothyrodism).

13. (iii) Environmental factors:(iii) Environmental factors:
Environmental factors may also be involved in prenatal
development of MR. they may include:
Exposure to Chemical Agents:
such as Alcohol, or nonprescription drugs ingested by the
mother during pregnancy
Maternal Conditions :
such as Hyperphenylalaninemia (PKU) , Toxemia,
Hypertension, Diabetes
Congenital Infections:
Such as : Cytomegalovirus, Rubella and Syphilis. (TORCH)

14. Genetic Causes :Genetic Causes :
Genetic causes can be divided into Two causes :
•Single gene Disorders
•Chromosomal abnormalities
Single gene disorders : it follow specific patterns of
transmission: Autosomal dominant, autosomal recessive,
or sex-linked.
Chromosomal aberrations: it include missing or extra
chromosome, either in part, such a s a short arm or a total
chromosome, as found in trisomal type.
The patern of transmission are not as readily identified as
those of specific gene defects.

15. Single gene disorders
TYPE AUTOSOMA
L
DOMINANT
AUTOSOMAL
RECESSIVE
SEX LINKED
Transmis
sion
Pattern
Either parent
carries gene
or
spontaneous
transmission
Both parents
are carriers
Either parent can transmit
gene:mother usually a carrier ,
father can not be a carrier but can
have the disorder
Risk
Factors
50% risk of
child being
affected with
each
pregnancy
25% risk of
child being
affected
If mother has affected gene then
25% risk of Carrier daughter/
affected son.
If Father has an affecte gene then all
daughter will be carriers ans son
normal.
Sex
Distrib-
ution
Male female
children
equally at
Risk
Male femal
children
equally at risk
Primally male children at risk,
female children at risk for becoming
Carriers.

16. Environmental Influences;
Pre-natal Factors;
 Maternal Infections: including Rubella, Cytomegalovirus, Toxoplasmosis
and Syphilis.(TORCH)
Low Birth Weight:Due to Prematurity or Intra-uterine Growth
Retardation
Or some Maternal causes such as lack of Prenatal care, Placental
Insufficiency , Toxemia, Smoking, Infections and Poor Nutrition.
Exposure to Industrial Chemicals cam also effect birth weight.
Peri-natal factors;
Two major Causative factors :
Mechanical Injuries at Birth and
Perinatal Hypoxia
Postnatal factors;
Traumas /Infections;
due to mechanical injury to brain or Hypoxia
Traumas include: Child abuse and Closed head Injuries. And Infections
include Encephalitis and meningitis
Environmental Influences;
Another major Post natal factor is the environmental influences.

17. Incidence and
Prevalence;
MR is the Most Frequently occuring
developmetal disability
Estimates of the prevalence of MR in
America range from 1% to 3%.
A recent review of prevalence studies found
that 2.5 % to 3 % is probaby an accurate
estimate of distribution in the general
population.
Boys are 1.5 times more likely to experience
MR than girls which may be related to the sex
linked genetic disoder that result in MR.

18. Signs and Symptoms;Signs and Symptoms;
 One study results found that two third of the children
with severe MR (IQ <50) had an additional neurological
diagnosis. these diagnosis include conditions such as :
Epilepsy, Cerebral Palsy, and hearing and Visual
impairments.
 With Certain Genetic Conditions, Such s Downs
Syndrome, MR is one of the clinical signs of the condition.
 MR is defined by the AAMR as the condition that is
present from childhood (below age 18) with an IQ below 70
to 75 as measured on standardize tests and significant
limitations in two or more adaptive skill areas.
MR is classified according to the severity of Impairments in
intellectual functioning, this is determined through
standardized intelligence tests.
The level of MR as identified by IQ tests are : Mild,
Moderate, Severe and Profound.
85% are in the mild ranges, 10% are in moderate, 3.5% are
in Severe range and 1.5 % are in the profound range.

19. LEVELS OF RETARDATION
Classifica
-tion
IQ range When
Identifi
ed
Adaptive Behavior as Adult
Profoun
d
Less than
20 / 25
InfancyIndependent functioning:Independent functioning:
•Requires total supervision
•Dependent on others for personal care
Communication:Communication:
•Very minimal Language,
Occupation:Occupation:
•Minimal participation
Severe 20/25 –
35/40
Early
Child-
hood
Independent Functioning:Independent Functioning:
Can contribute partially to self care with
total supervision.
Communication;Communication;
Care engage in simple conversation
Recognizes signs and selected words.
Occupation:Occupation:
May prepare simple foods, can helpwith
simple household tasks, requires
supervision.

20. Moder
ate
35/40
–
50/55
Early
Childhoo
d
Independent functioningIndependent functioning: Feeds, bathes, and
dresses self; prepares simple foods for self and
others; able to care for own hair.
May function semi-independently in
supervised living situation.
Communication; Communication; Carries on simple
conversations, uses complex sentences,
recognizes words, reads sentences and signs
with comprehension.
Occupation: Occupation: May do simple Routine household
chores. Prepares food requiring mixing, May
Function in supported employment or shelter
workshop settings, Can learns some functional
Living skills.
Mild 50/55-
70/75
Elementa
ry School
Independent FunctioningIndependent Functioning: : Exercise care for
Personnel Grooming, feeding, bathing and
toileting. May need personal care reminders.
Occupation: Occupation: Prepares meals, Perform
everyday household tasks,
Can hold semi-skilled or simple skilled job.
Classi
ficatio
n
IQ
range
When
Identified
Adaptive Behavior as Adult

21. Course and Prognosis;Course and Prognosis;
MR is generally considered a life long condition,
but the Course and prognosis vary according to the
cause of the retardation.
Most cases of MR are “Non-Progressive”. And the
emphasis is on the management of the condition.
However Certain genetic conditions (e.g; muscular
dystrophy, and Tay – Sachs disease are progressive.
The Goal for these individuals is to help them
achieve the highest level of independence and
maintain it as long as possible.
It is Possible for mild MR to gain adaptive skills
through remedial programs to the extent that they
no longer meet the diagnostic criterion for being MR
, although Intellectual function has not changes
significantly.

22. THANK YOU!!!