Mental Retardation

significantly sub-average general intellectual functioning w/ deficits in adaptive behaviour during developmental period. (Nelsons 18th edition) significantly subaverage general intellectual functioning resulting in, or associated with, concurrent impairment in adaptive behavior and manifested during the developmental period, before the age of 18 (DSM-IV-TR) includes deficits in cognitive abilities as well as in behaviors required for social and personal sufficiency, known as adaptive functioning. (Kaplan and Saddocks 10th edition)

Diagnosis
history, a standardized intellectual assessment, and a measure of adaptive function

 American Psychiatric Association (APA): intellectual (most common used)

Degree of severity Mild Mental Retardation Moderate Mental Retardation Severe Mental Retardation Profound Mental Retardation Mental Retardation, Severity unspecified IQ level 50-55 to = 70 IQ level 35-40 to 50-55 IQ level 20-25 to 35-40 IQ level below 20-25 Strong presumption but untestable

American Association on Mental Retardation (AAMR): adaptive

Diagnostic Criteria for Mental Retardation A. Significantly sub-average intellectual functioning: IQ </= 70 B. Concurrent deficits or impairments in present adaptive functioning (communication, self-care, home living, social, skills, community resources, self-direction, academic, skills, work, leisure, health and safety. C. Onset is before 18 years old

Developmental Characteristics of Mentally Retarded Persons

Preschool Age (0 to 5 yrs) Maturation and Development School Age (6 to 20 yrs) Training and Education Adult (21 yrs and Above) Social and Vocational Adequacy

Profound Gross retardation; minimal Some motor development present; capacity for functioning in may respond to minimal or limited sensorimotor areas; needs training in self-help nursing care; constant aid and supervision required Severe Poor motor development; speech minimal; generally unable to profit from training in self-help; little or no communication skills

Some motor and speech development; may achieve very limited self-care; needs nursing care

Can talk or learn to communicate; can May contribute partially to selfbe trained in elemental health habits; maintenance under complete profits from systematic habit training; supervision; can develop selfunable to profit from vocational protection skills to a minimal useful training level in controlled environment Can profit from training in social and May achieve self-maintenance in occupational skills; unlikely to unskilled or semiskilled work under progress beyond second-grade level in sheltered conditions; needs academic subjects; may learn to travel supervision and guidance when under alone in familiar places mild social or economic stress

Moderate Can talk or learn to communicate; poor social awareness; fair motor development; profits from training in self-help; can be managed with moderate supervision Mild Can develop social and communication skills; minimal retardation in sensorimotor areas; often not distinguished from normal until later age

Can learn academic skills up to approximately sixth-grade level by late teens; can be guided toward social conformity

Can usually achieve social and vocational skills adequate to minimal self-support, but may need guidance and assistance when under unusual social or economic stress

 Physical Examination, Neurologic Exam Most commonly used medical diagnostic: metabolic, genetic, and chromosomal blood testing, and EEG. Psychological Assessment

Treatment
based on an assessment of social, educational, psychiatric, and environmental need. associated with a variety of comorbid psychiatric disorders that often require specific treatment, in addition to psychosocial support. primary, secondary, and tertiary prevention.

 Education for the Child Behavioral, Cognitive, and Psychodynamic Therapies SPED education Family Education Social Intervention Pharmacology

Prognosis
underlying intellectual impairment does not improve affected person's level of adaptation can be influenced positively by an enriched and supportive environment mild and moderate mental retardation have the most flexibility in adapting to various environmental conditions

Ref: Nelsons 18th edition Kaplan and Saddocks 10th edition DSM-IV-TR