Mental Retardation

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Intellectual Disability (Mental Retardation)

Topic:

1.     Intellectual Disability (Mental Retardation)

1.Intellectual Disability (Mental Retardation
2.     What is intellectual disability?

3. Levels of Mental Retardation

4.  What are the signs of intellectual disability in children? 

5.  What causes intellectual disability?

6. Behavioral Issues

7.  How Is Mental Retardation Diagnosed? 

8. Treatment Options for Mental Retardation

 9. Clinical Manifestations:

1.     What is intellectual disability?

Mental retardation or intellectual disability, (MR/ID), exists in children whose brains do not develop properly or function within the normal range. There are four levels of retardation: mild, moderate, severe, and profound. Sometimes, MR/ID may be classified as other or unspecified. Mental retardation involves both a low IQ and problems adjusting to everyday life.

MR/ID can result in learning, speech, physical, and social disabilities. Severe cases are diagnosed at birth. However, milder forms might not be noticed until a child fails to meet a common developmental goal. Almost all cases of MR/ID are diagnosed by the time a child reaches 18 years of age.

Intellectual disability (ID), once called mental retardation, is characterized by below-average intelligence or mental ability and a lack of skills necessary for day-to-day living. People with intellectual disabilities can and do learn new skills, but they learn them more slowly. There are varying degrees of intellectual disability, from mild to profound.

2.What is intellectual disability?

Someone with intellectual disability has limitations in two areas. These areas are:

·         Intellectual functioning. Also known as IQ, this refers to a person’s ability to learn, reason, make decisions, and solve problems.

·         Adaptive behaviors. These are skills necessary for day-to-day life, such as being able to communicate effectively, interact with others, and take care of oneself.

IQ (intelligence quotient) is measured by an IQ test. The average IQ is 100. A person is considered intellectually disabled if he or she has an IQ of less than 70 to 75.

To measure a child’s adaptive behaviors, a specialist will observe the child’s skills and compare them to other children of the same age. Things that may be observed include how well the child can feed or dress himself or herself; how well the child is able to communicate with and understand others; and how the child interacts with family, friends, and other children of the same age.

Intellectual disability is thought to affect about 1% of the population. Of those affected, 85% have mild intellectual disability. This means they are just a little slower than average to learn new information or skills. With the right support, most will be able to live independently as adults.

3.Levels of Mental Retardation

MR/ID is divided into four levels based on IQ and degree of social adjustment.

Mild Mental Retardation

At this level, a person:

·         takes longer to learn to talk, but can communicate well once he or she knows how

·         fully independent in self-care

·         has problems with reading and writing

·         is socially immature

·         is unable to deal with responsibilities of marriage or parenting

·         may benefit from specialized education plans

·         has an IQ range of 50 to 69

·         may have associated conditions, including autism, epilepsy, or physical disability

Moderate Mental Retardation

At this level, a person:

·         is slow in understanding and using language

·         has only a limited ability to communicate

·         can learn basic reading, writing, counting skills

·         is a slow learner

·         is unable to live alone

·         can get around on own

·         can take part in simple social activities

·         has an IQ range of 35 to 49

Severe Mental Retardation

At this level, a person:

·         has noticeable motor impairment

·         has severe damage to and/or abnormal development of central nervous system

·         has an IQ range of 20 to 34

Profound Mental Retardation

At this level, a person:

·         is unable to understand or comply with requests or instructions

·         is immobile

·         must wear adult diapers

·         uses very basic nonverbal communication

·         cannot care for own needs

·         requires constant help and supervision

·         has an IQ of less than 20

4.What are the signs of intellectual disability in children?

There are many different signs of intellectual disability in children. Signs may appear during infancy, or they may not be noticeable until a child reaches school age. It often depends on the severity of the disability. Some of the most common signs of intellectual disability are:

·         Rolling over, sitting up, crawling, or walking late

·         Talking late or having trouble with talking

·         Slow to master things like potty training, dressing, and feeding himself or herself

·         Difficulty remembering things

·         Inability to connect actions with consequences

·         Behavior problems such as explosive tantrums

·         Difficulty with problem-solving or logical thinking

·          

• Language delay: One of the first signs of MR/ID may be language delays, including delays in expressive language (speech) and receptive language (understanding)
• Fine motor/adaptive delay: Significant delays in activities such as self-feeding, toileting, and dressing are typically reported in children with MR/ID
• Cognitive delay: Difficulties with memory, problem-solving, and logical reasoning
• Social delays: Lack of interest in age-appropriate toys and delays in imaginative play and reciprocal play with age-matched peers
• Gross motor developmental delays: Infrequently accompany the cognitive, language, and fine motor/adaptive delays associated with MR/ID unless the underlying condition results in both MR/ID and cerebral palsy.
• Behavioral disturbances: Infants and toddlers may be more likely to have difficult temperaments, hyperactivity, disordered sleep, and colic; associated behaviors may include aggression, self-injury, defiance, inattention, hyperactivity, sleep disturbances, and stereotypic behaviors.
• Neurologic and physical abnormalities: Prevalence of MR/ID is increased among children with seizure disorders, microcephaly, macrocephaly, history of intrauterine or postnatal growth retardation, prematurity, and congenital anomalies

In children with severe or profound intellectual disability, there may be other health problems as well. These problems may include seizures, mental disorders, motor handicaps, vision problems, or hearing problems.

5.What causes intellectual disability?

Anytime something interferes with normal brain development, intellectual disability can result. However, a specific cause for intellectual disability can only be pinpointed about a third of the time.

The most common causes of intellectual disability are:

·         Genetic conditions. These include things like Down syndrome and fragile Xsyndrome.

·         Problems during pregnancy. Things that can interfere with fetal brain development include alcohol or drug use, malnutrition, certain infections, or preeclampsia.

·         Problems during childbirth. Intellectual disability may result if a baby is deprived of oxygen during childbirth or born extremely premature.

·         Illness or injury. Infections like meningitis, whooping cough, or the measles can lead to intellectual disability. Severe head injury, near-drowning, extreme malnutrition, exposure to toxic substances such as lead, and severe neglect or abuse can also cause it.

6.Individuals who are intellectually disabled will often have some of the following behavioral issues:

·         aggression

·         dependency

·         withdrawal from social activities

·         attention-seeking behavior

·         depression during adolescent and teen years

·         lack of impulse control

·         passivity

·         tendency toward self-injury

·         stubbornness

·         low self-esteem

·         low tolerance for frustration

·         psychotic disorders

·         attention difficulties

Physical signs of MR/ID include short stature and malformed facial features. However, physical signs are not always present.

7. How Is Mental Retardation Diagnosed?

Etiology:

A diagnosis of mental retardation cannot be made on the basis of intellectual ability alone; there must be both intellectual and adaptive (personal independence and social responsibility) impairment.

A diagnosis of MR/ID requires that both intellectual and adaptive skills be well below average. There are three parts to the evaluation:

·         interviews with parents

·         observations of the child

·         standard tests

Your child will be given standard intelligence tests, such as the Stanford-Binet Intelligence Test, to determine IQ. Other tests, such as the Vineland Adaptive Behavior Scales, will be given to assess your child’s daily living skills and social abilities compared with other children in the same age group. It is important to remember that children from different cultures and socio-economic statuses may perform differently on these tests. Results of these tests will be combined with information obtained from interviews with parents and observations of the child to assist in the diagnosis.

The screening process might include visits to many different professionals including the following:

·         psychologist

·         speech pathologist

·         social worker

·         pediatric neurologist

·         developmental pediatrician

·         physical therapist

Laboratory and imaging tests may be performed as well to detect metabolic and genetic disorders and structural problems with the brain. It is important to rule out such things as hearing loss, learning disorders, neurological disorders, and emotional problems as the cause for delayed development before making a diagnosis of MR/ID.

Once MR/ID has been diagnosed, the family, school, and primary care physician will use the results of these tests and evaluations to develop a treatment and education plan.

8. Treatment Options for Mental Retardation

Ongoing counseling will often be needed to help the child cope with disabilities.

Parents with intellectually disabled infants and toddlers will get a family service plan that describes their child’s needs. The plan will also detail the services the child will need to help him or her with normal development. Family needs are also addressed in the plan.

When the child is ready to attend school, a new plan, called the Individualized Education Program (IEP), will be put in place to assist the child with his or her educational needs.

The main goal of treatment is to assist the child in reaching his or her full potential in terms of education and social and life skills. Treatment may include behavior therapy, occupational therapy, counseling, and in some cases, medication. All children with MR/ID benefit from special education, and the federal Individuals with Disabilities Act (IDEA) requires that public schools provide free and appropriate education to children with mental retardation and other developmental disabilities.

What Is the Long-Term Outlook?

When MR/ID occurs with other serious physical problems, the life expectancy of the child may be shortened. In general, the more severe the cognitive disability and the more physical problems the child has, the shorter the life expectancy. However, a child with mild to moderate MR/ID has a fairly normal life expectancy. As adults, these people can often be successful at jobs that require basic intellectual skills, can live independently, and can support themselves.

Essential update: FDA approves new genetic test for evaluation of intellectual disabilities

The US Food and Drug Administration (FDA) has approved a postnatal blood test for detecting chromosomal variations that produce developmental delays or MR/ID. In a comparison of tests on 960 blood specimens, studies with the CytoScan Dx Assay (Affymetrix), which analyzes a patient's entire genome, were superior to other genetic tests, including karyotyping and fluorescence in situ hybridization (FISH) chromosomal tests, used for the same purpose.

Evaluation of patients for MR/ID can include the following examinations:

·         Head circumference: Microcephaly correlates highly with cognitive deficits; macrocephaly may indicate hydrocephalus, is associated with some inborn errors of metabolism, and may be seen early on in some children later diagnosed with autism^.

·         Height: Short stature may suggest a genetic disorder, fetal alcohol syndrome, or hypothyroidism; tall stature may suggest fragile X syndrome (FraX), Soto syndrome, or some other overgrowth syndrome associated with MR/ID

·         Neurologic: This examination should include assessments of head growth (for microcephaly/macrocephaly), muscle tone (for hypotonia or spasticity), strength and coordination, deep tendon reflexes, persistent primitive reflexes, ataxia, and other abnormal movements, such as dystonia or athetosis.

·         Sensory: Children with disabilities and MR/ID are more likely than other children to have visual impairment and hearing deficits

·         Skin: Findings can include hyperpigmented and hypopigmented macules, such as café-au-lait macules (associated with neurofibromatosis type 1), as well as ash-leaf spots (associated with tuberous sclerosis), fibromas, and irregular pigmentation patterns

·         Extremities: Although MR/ID with multiple congenital anomalies and major malformations accounts for only 5-10% of all cases, most of these affected individuals have 3-4 minor anomalies, especially involving the face and digits.

Imaging studies

·         Brain magnetic resonance imaging (MRI): Should be conducted in any child with global developmental delays or MR/ID

·         Head computed tomography (CT) scanning: Preferred imaging study for calcifications that may be identified with TORCH infections (ie, toxoplasmosis, other infections, rubella, cytomegalovirus [CMV], herpes simplex) or when tuberous sclerosis is suspected or craniosynostosis is a concern

·         Skeletal films: Assist with phenotypic description, syndrome characterization, and assessment of growth

9. Clinical Manifestations:

Findings may vary depending on the classification or degree of retardation.

Classification	Manifestations
	Preschool	School-age	Adult
Mild (50-70 IQ)	The child often is not noted as retarded, but is slow to walk, talk and feed self.	The child can acquire practical skills, and learn to read and do arithmetic to sixth grade level with special education classes. The child achieves a mental age of 8 to 12 years	The adult can usually achieve social and vocational skills. Occasional guidance may be needed. The adult may handle marriage, but not child rearing.
Moderate (35-55 IQ)	Noticeable delays, especially in speech are evident.	The child can learn simple communication, health, and safety habits, and simple manual skills. A mental age of 3 to 7 years is achieved.	The adult can perform simple tasks under sheltered conditions and can travel alone to familiar places. Help with self-maintenance is usually needed.
Severe (20-40 IQ)	The child exhibits marked motor delay and has little to no communication skills. The child may respond to training inelementary self-help, such as feeding.	The child usually walks with disability. Some understanding of speech and response is evident. The child can respond to habit training and has the mental age of a toddler.	The adult can conform to daily routines and repetitive activities, but needs constant direction and supervision in a protective environment.
Profound (below 20 IQ)	Gross retardation is evident. There is a capacity for function in sensorimotor areas, but the child needs total care.	There are obvious delays in all areas. The child shows basic emotional response and may respond to skillful training in the use of legs, hands and jaws. The child needs close supervision and has the mental age of a young infant.	The adult may walk but needs complete custodial care. The adult will have primitive speech. Regular physical activity is beneficial.

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