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Terminology
In ICD-10 and DSM- the term mental retardation denotes intellectual impairment starting early in life (as distinct from dementia, which is intellectual impairment developing later in life ) Other terms of this condition include mental deficiency, mental subnormality, mental handicap, and most recently, learning difficulties.
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Terminology
Although the central feature is intellectual impairment, the definition of mental retardation should include social criteria for the practical purpose of distinguishing between people who can and those who cannot lead a near-normal life. Thus in DSM- the definition of mental retardation includes not only intellectual impairment but also the phrase with concurrent deficits and impairments in adaptive behavior, taking into account the persons age
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Terminology
Subgroups of mental retardation are recognized according to the degree of impairment: mild (IQ 50-70) moderate (IQ 35-49) severe (IQ 20-34) and profound (IQ below 20).
Epidemiology
Among the population aged 15-19,the prevalence of moderate and severe mental retardation is about 3.0 to 4.0 per thousand The prevalence of mental disorder among the mentally retarded increase with the severity of the retardation Among people with mild mental retardation the prevalence of mental disorder is similar to that among people of normal intelligence, but among people with severe retardation it is greater
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Clinical features of MR
the characteristic feature is low performance of all kinds of intellectual functioning including learning, short-term memory, the use of concepts, and problem solving. Sometimes one specific function is impaired more than the rest, for example the use of language any of the common behavioral problems of childhood
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Types of retardation
Mild
IQ50-70 80 percent of all retarded Specific causes uncommon Many need practical help and education Few need special psychiatric or social services
Types of retardation
Moderate
IQ 35-49 12 per cent of all retarded Most can manage some independent activities Require special education, occupation, and supervision
Types of retardation
Severe
IQ 20-34 7 per cent of all retarded Specific causes usual Social skills severely limited Require close supervision and much practical help
Types of retardation
Profound
IQ below 20 1 per cent of all retarded Specific causes usual Very severely disabled Physical problems usual Very poor self-care
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Physical disorders
Among the severely and profoundly retarded, most have physical problems such as sensory or motor disabilities, or epilepsy. Disorders of hearing or vision are important additional obstacles. Motor disabilities are frequent including spasticity, ataxia, and athetosis
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Psychiatric disorder
All kinds of psychiatric disorder can occur in the mentally retarded. Diagnosis is often difficult because symptoms may be modified by low intelligence
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Psychiatric disorder
Schizophrenia Affective disorder Adjustment disorder and neurosis Personality disorder Organic psychiatric disorder Overactivity and autistic behavior Sexual problems
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They often experience prolonged depression, with guilt, shame, or anger A few parents reject the child, while others become overinvolved in caring for the child to the detriment of their other children Most parents eventually achieve a satisfactory adjustment, although they are still tempted to overindulge the child However well they adjust psychologically, parents are faced with the prospect of prolonged hard work and social problems. If the child also has a physical handicap, these problems are increased.
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Aetiology
Mild mental retardation is usually due to a combination of genetic and adverse environment factors Severe mental retardation is usually due to pathological conditions, of which most can be diagnosed in life and about two thirds before birth. Both mild and severe retardation are more common in the lower social classes, possibly because of less effective preventive measures
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Aetiology
General causes much mild mental retardation represents the lower end of the normal disturbance of intelligence which is mainly determined by polygenic inheritance. Specific genetic abnormalities are responsible for many of the metabolic and other disorders that causes severe retardation. Some of these causes are discussed further below
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Aetiology
Social factors: low IQ is associated with lower social class, poverty, poor housing, and an unstable family environment Antenatal damage may be caused by intrauterine infection or toxic substances. Perinatal damage: the causes include birth injury, kernicterus, and intraventricular hemorrhage. Clinically recognizable brain injuries at birth account for about 10 per cent of mental retardation.
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Aetiology
Post-natal damage: may be due to injury, infections, and lead intoxication Malnutrition is a common cause in developing countries, though much less common in developed countries
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Specific causes
Genetic causes dominant conditions: neurofibromatosis and tuberose sclerosis are examples of these rare conditions recessive conditions: this is the largest group of specific disorders and includes most of the inherited metabolic conditions such as phenylketonuria, homocystinuria, and galactosaemia
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Specific causes
chromosome abnormalities : the most common chromosome abnormality is Downs syndrome. Abnormalities in the number of sex chromosomes, such as Klinefelters syndrome and Turners syndrome, may also cause retardation sex-linked conditions conditional known to be inherited but in a less well understood way: such as microcephaly
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Assessment
Severe mental retardation can usually diagnosed in infancy, as it is often associated with physical abnormalities or delayed motor development. The diagnosis of less severe mental retardation is more difficult because it is based on delays in psychological development
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Assessment
History taking Physical examination Behavioral assessment
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Assessment
Developmental testing Overall assessment Services for the mentally retarded
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