MENTAL RETARDATION

Introduction

Disability is the functional inability of an individual to

perform any activity in a manner or within the range

consider normal for any human being.

Human disabilities are permanent condition. They usually manifest at birth, or sometimes may be acquired later in life.

Various types of disabilities are:

Physical/Locomotion,

Visual, Hearing,
Mental, Learning Or Multiple Handicaps.

Mental Retardation

Older terms: Mentally deficient Idiots Imbecile Moron Presently, such insulting terms are not used. Terms

such as persons who are mentally challenged or a

person who are differently abled are being used.

Definition

Mental retardation is identified as significantly sub average level of intellectual functioning associated with deficits in adaptive behaviour and manifesting during the development period (Grossman, 1972).

Mental

retardation

is

defined

as

disability

characterized by significant limitations both in

intellectual functioning and adaptive behaviour as

expresses in conceptual, social and practical adaptive skills. The disability originates before age of eighteen (American Association of Mental Deficiency, 2002).

Characteristics

Mental retardation is not a disease. It is not something like one has a blue eyes or skin complexion.

It is not a medical disorder or mental disorder. It is a condition of low intelligence. It is a particular state of functioning that begins in

childhood. It is characterized by limitations in

intelligence and skills of adaptive behaviour.

Intelligence and Adaptive Behaviour

Intelligence is defined as Global capacity of an

individual to think rationally, act purposefully

and solve problems in life (Wechsler, 1972).

Intelligence is calculated using a standardized test of intelligence.

It is expressed in numerical index called Intelligence Quotient (IQ)

The persons ability to adapt to demands of daily

living is measured as Social Quotient (SQ).

In infants and preschoolers, IQ is more aptly measured as Development Quotient (DQ). Unlike IQ, DQ of young children are liable to change owing to growth and training.

Mental age
Chronological Age

100

Any person with intellectual capacity less than 70 percent of his physical or chronological age is called as mentally retarded.

Formula of IQ

Grades/ Severity Level of Mental Retardation

Severity Level
Mild MR Moderate MR Severe MR

Range of IQ
50-69 35-49 20-34

Profound MR

Below 20

Features of Mental Retardation

1. 2. 3.

Slow rate of development since birth in all areas.

Discrepancy between physical and mental age.

Poor academic performance with repeated failure at school.

4.

Dependence on others for carrying out day to day activities like bathing, dressing etc.

5.

Appearance of being dull, being slow in understanding, memory, attention-concentration, thinking, problem solving and decision making.

6. 7.

History of delay in all developmental milestones.

Difficulty in expression and control of feelings and emotions.

8.

Disturbance in expressive or receptive communication

skills. Difficulty in managing money, lack of time skill for his age. Incompetence in performing vocational activities or lack of social skills for age. Associated features like behaviour problems, fits or sensory handicap may be present.

9.

10.

11.

Mental Retardation and Mental Illness

Mental Retardation Disability Onset before 18 years Low level of intelligence Mental Illness Disease Occur at any time in persons life Symptoms like talking to self, laughing for no reason, crying spells, hearing voices etc. Rehabilitation No permanent cure e.g. Down syndrome

Habilitation Can be cured completely e.g. Psychosis (schizophrenia and mood disorder), Neurosis (anxiety, phobia, obsessive compulsive disorder)

Mental retardation should not be confused with

Slow Learners

Autism
Expressive Language Delay Conduct Disorder Learning Disability

Mental Retardation is not

Slow learners are children in intelligence range of

70-89.

A child/adult with average level of intelligence will

have IQ range of 90-110.

Slow Learners

 ELD

are seen in children with less than their

speech or language development. They are age

appropriate in all others areas of speech

development.

Expressive Language Delay (ELD)

The children with conduct problem have sever behaviour problems. They throw temper tantrums, remain stubborn,

refuse to obey commands, throw things, bang their own

head, hurt others etc.

Conduct Disorder

Children with learning disability have problems only

in reading, writing, spelling and arithmetic despite having average or above average intelligence, good health, effective hearing and vision or adequate schooling.

Learning Disability

Prevalence

WHO report suggests that 5.21% of population in developing countries is disabled.

According to Indian estimates, about 2-3% of population is person with mental retardation.

There are reports on more number of people with

mental retardation from rural than urban areas.

It is found that in any given population, there is more number of mild than moderate, severe or profound mental retardation.

Causes Of Mental Retardation

Mental retardation is the result as well as the interaction of several causes in any affected individual. There are more than 500 identified causes of mental retardation.

The causes of mental retardation in any individual may

vary.

One can identify the cause of mental retardation in only 60% of cases, remaining 40% of cases the cause of mental retardation can not be known even with modern medical equipments and technology.

Causes- Prenatal
Maternal

illness Harmful effect of drugs Fall or trauma German measles to mother

Causes- Natal
Absent

birth cry Lack of oxygen supply to new born Low birth weight Difficult or delayed labor Infection at the time of birth

Causes- Postnatal
Fits after delivery injury

Chromosomal

A chromosome is an organized structure of DNA and protein found in cells. Deoxyribonucleic

acid (DNA) contain the genetic instructions used in the development and functioning of all known living organism. Humans have two sets of 23 chromosomes in every cell, one set inherited from

each parent, (22 pairs of autosomes and one pair of

sex chromosomes), giving a total of 46 per cell.

Chromosome abnormalities are visible alteration of

chromosomes. Chromosome complements are

subject

to

two

kinds

of changes-(1) numerical

and (2) structural and they may affect either sex chromosomes or autosomes.

Chromosomal

Down Syndrome (Trisomy 21)

Patau Syndrome (Trisomy 13)

Edward Syndrome (Tyrisomy 18)

Turners Syndrome

Klinefelters Syndrome

Congenital

A congenital disorder, or congenital disease, is a condition existing at birth and often before birth, or that develops during the first month of life (neonataldisease), regardless of causation

Microcephaly is a neurodevelopmental disorder in which the circumference of the head is more than two standard deviations smaller than average for the person's age and sex

Microcephaly

Macrocephaly , occurs when the head is abnormally large

Macrocephaly

Cleft lip and palate are birth defects that affect the upper lip and the roof of the mouth.

Cleft lip and palate

Spina bifida is a developmental congenital disorder caused by the incomplete closing of the embryonic neural tube. Some vertebrate overlying the spinal cord are not fully formed and remain unfused and open

Spina bifida

Nutritional
Protein energy malnutrition Marasmus: Marasmus is a form of severe proteinenergy malnutrition characterized by energy deficiency. A child with marasmus looks emaciated. Body weight may be reduced to less than 80% of the average weight that corresponds to the height

Kwashiorkor: Kwashiorkor is an acute form of childhood protein-energy malnutrition characterized by edema, irritability, anorexia, ulcerating dermatoses, and an enlarged liver.

Metabolic

Metabolism

is the set of chemical reactions that

happen in the cells of living organisms to sustain life.

These processes allow organisms to grow and reproduce, maintain their structures, and respond to their environments. The word metabolism can also refer to all chemical reactions that occur in living organisms, including digestion and the transport of substances into and between different cells.

Protein is made up of smaller building blocks

called amino acid. A number of different enzymes are

needed to process these amino acids for use by the

body. Because of missing or non-working enzymes, people with amino acid disorders cannot process certain amino acids. These amino acids, along with other toxic substances, then build up in the body and cause problems.

Phenylketonuria (PKU) is Phenylketonuria is an

inherited disorder that increases the levels of a substance called phenylalanine in the blood due to absence of an

enzyme called phenylalanine hydroxylase. Phenylalanine

is a building block of proteins (an amino acid) that is obtained through the diet. It is found in all proteins and in

some artificial sweeteners. If PKU is not treated,

phenylalanine can build up to harmful levels in the body, causing intellectual disability and other serious health problems.

PHENYLKETONURIA

Homocystinuria is an inherited condition that affects

the way a persons body uses a part of food called methionine (a precursor to homocystine, that is, an amino acid from which homocystine is made). A person with homocystinuria cannot breakdown the

methionine in food. Methionine and homocystine are

amino acids needed for proper growth and development, but too much can cause serious health problems.

HOMOCYSTINURIA

In the case of classical homocystinuria, too much

methionine builds up in the blood, which in turn causes a buildup of homocystine. High levels of methionine and homocystine penetrate and damage the brain. These high levels ultimately cause mental retardation and other serious health problems.

HOMOCYSTINURIA

Galactosemia is a disorder that affects how the body

processes a simple sugar called galactose. A small amount of galactose is present in many foods. It is primarily part of a larger sugar called lactose, which is found in all dairy products and many baby formulas. The

signs and symptoms of galactosemia result from an

inability to use galactose to produce energy due to absence of enzyme responsible for adequate

galactose degradation.

GALACTOSEMIA

Harmonal

A hormone is a chemical

released by a gland in
one part of the body that sends out messages that affect cells in other parts of the organism

Hypothyroidism is a condition characterized by

abnormally Because inadequate development, low thyroid and thyroid thyroid many hormone affects cellular has production. growth, processes, widespread hormone hormone

consequences for the body. Some common symptoms

are increased sensitivity to cold, constipation, weight gain, fatigue, muscle cramps and joint pain, Poor muscle tone, Female infertility etc.

HYPOTHYRODISM

Cretinism (also called Neonatal hypothyroidism) is

caused due to is decreased thyroid hormone production in a newborn. In very rare cases, no thyroid hormone is produced. If the baby was born with the condition, it is called congenital hypothyroidism. If it develops soon after birth, it is called hypothyroidism acquired in the newborn

period.

CRETINISM

Infants with severe hypothyroidism often have a unique appearance, including:

Dull look Puffy face Thick tongue that sticks out .This appearance usually

develops as the disease gets worse.

The child may also have:

Choking episodes, Constipation, Dry, brittle hair, Lack of muscle tone, Poor feeding, Short height, Sleepiness

CRETINISM

Acromegaly is a long-term condition in which there

is too much growth hormone and the body tissues get

larger over time. Excessive production of growth

hormone in children causes gigantism rather than acromegaly.

ACROMEGALY

The cause of the increased growth hormone release is

usually a noncancerous (benign) tumor of the

pituitary gland. The pituitary gland, which is located

just below the brain, controls the production and release of several different hormones, including growth hormone.

ACROMEGALY

Infections

TUBERCULOUS MENINGITIS is an infection of

the membranes covering the brain and spinal cord

(meninges). Tuberculous meningitis is caused

by Mycobacterium tuberculosis, the bacteria that cause tuberculosis. The bacteria spread to the brain from another site in the body.

The symptoms usually begin gradually, and may

include: Fever and chills, Nausea and vomiting,

Sensitivity to light (photophobia), Severe headache,

Stiff neck (meningismus)

TUBERCULOUS MENINGITIS

Japanese encephalitis is a viral disease that infects animals and humans. It is transmitted by mosquitoes and in humans causes inflammation of the membranes around the brain. Domestic pigs and wild birds are reservoirs of the virus; transmission to humans may cause severe

symptoms. Fever, headache non-specific symptoms of

this disease. Signs which develop during the acute encephalitic stage include neck rigidity, hemiparesis, convulsions and a raised body temperature

JAPANESE ENCEPHALITIS

Brain fever describes a medical condition where a

part of the brain becomes inflamed and causes symptoms that present as fever. Conditions that may be described as brain fever include:

Encephalitis , an acute inflammation of the brain, commonly caused by a viral infection.

Meningitis, the inflammation of the membranes covering the brain and spinal cord

BRAIN FEVER

FAMILIAL/ GENETIC

Runs in families

SOCIAL CULTURAL

Impoverished environment Poor environmental stimulation