02-03-2012

Dept. of Pediatrics, FMMC.

MENTAL RETARDATION

 Significantly subaverage general intellegence, with onset during early developmental period, and concurrent deficits in adaptive functioning.

WHAT IS MR?

IQ< 2SD below the mean (<70) Deficits in adaptive behaviour during developmental period (<18 yrs)

02-03-2012

Dept. of Pediatrics, FMMC.

IS THE CHILD REALLY RETARDED?

A) Whether there is significant delay?

Checklist of mile stones, prematurity, recent illness Compare with siblings & peers Normal Variation Neuromuscular disorder CP PEM Chronic illness Autism & Psychosis Emotional deprivation

B) Conditions misdiagnosed as MR

02-03-2012

Dept. of Pediatrics, FMMC.

WHAT IS THE SEVERITY?

I. Q. 51-70 SEVERITY MILD SUPPORT Intermittent (Special times)

36-50
21-35 <21

MODERATE
SEVERE Profound

Limited (Employment)
Extensive (Daily living) Pervasive (Institutional)

02-03-2012

Dept. of Pediatrics, FMMC.

WHY DID IT HAPPEN? (ETIOLOGY)

MILD

Idiopathic (50%) Multifactorial Socio-economic Environmental

SEVERE

Chromosomal- 30%
Perinatal insult (20%) TORCH CNS Malformation (20%)

Downs Fragile-X

TREATABLE CONDITIONS Hypothyroidism PKU IDA

Toxin- Lead Nutrition- Iodine, Iron

Endocrine

Neural tube defects Hydrocephalus Hypothyroidism Phenyl Ketonuria

Metabolic

02-03-2012

Dept. of Pediatrics, FMMC.

EVALUATION

Detailed developmental history Assess the severity Identify the etiology

Look for treatable conditions Clinical features- family history Dysmorphic features Consanguinity in parents Affected family members Investigations

Emphasis on simple test/ treatable conditions Urine metabolic screening Chromosomal analysis Imaging
Dept. of Pediatrics, FMMC. 7

02-03-2012

MANAGEMENT

Specific treatment Symptomatic- anticonvulsants Supportive (Stimulation, Schooling, Vocational) Parent counselling

Prevention

Breaking the news Positive aspects Dont withhold the truth Family participation Recurrence risk

Primary (Environmental, Consanguinity, food supplements) Secondary (Early diagnosis/ Prenatal diagnosis)
Dept. of Pediatrics, FMMC. 8

02-03-2012