Mental retardation
Mental retardation: Excerpt from Professional Guide to Diseases (Eighth Edition)
The American Association on Mental Retardation (AAMR) defines mental retardation as “significantly subaverage general intellectual function existing concurrently with deficits in adaptive behavior manifesting itself during the developmental period (before age 18).” Retardation commonly is accompanied by other physical and emotional disorders that may constitute disabilities in themselves. Mental retardation places a significant burden on patients and their families, resulting in stress, frustration, and family problems.
Causes and incidence
A specific cause is identifiable in only about 25% of people who are mentally retarded, and, of these, only 10% have the potential for cure. (See Causes of mental retardation.) In the remaining 75%, predisposing factors, such as deficient prenatal or perinatal care, inadequate nutrition, poor social environment, and poor child-rearing practices, contribute significantly to mental retardation.
Prenatal screening for genetic defects (such as Tay-Sachs disease) and counseling for families at risk for specific defects have reduced the incidence of genetically transmitted mental retardation.
An estimated 1% to 3% of the population is mentally retarded, demonstrating an IQ below 70 and associated difficulty in carrying out tasks required for personal independence.
Signs and symptoms
The observable effects of mental retardation are deviations from normal adaptive behaviors, ranging from learning disabilities and uncontrollable behavior to severe cognitive and motor skill impairment. The earlier a child’s adaptive deficit is recognized and he’s placed in a special learning program, the more likely he is to achieve age-appropriate adaptive behaviors. If the patient is older, review his adaptation to his environment.
The family of a patient who’s mentally retarded may report many problems stemming from frustration, fear, and exhaustion. These problems, such as financial difficulties, abuse, and divorce, can compromise the child’s care. Physical examination may reveal signs of abuse or neglect.
People who are mentally retarded may exhibit signs and symptoms of other disorders, such as cleft lip, congenital heart defects, and cerebral palsy as well as a lowered resistance to infection.
Diagnosis
CONFIRMING DIAGNOSIS A score of less than 70 on a standardized IQ test confirms the diagnosis of mental retardation.
The IQ test primarily predicts school performance and must be supplemented by other diagnostic evaluations.
For example, the Adaptive Behavior Scale deals with behaviors important to activities of daily living. This test evaluates self-help skills (toileting and eating), physical and social development, language, socialization, and time and number concepts. It also examines inappropriate behaviors, such as violent or destructive acts, withdrawal, and self-abusive or sexually aberrant behavior.
Age-appropriate adaptive behaviors are assessed by using developmental screening tests such as the Denver Developmental Screening test. These tests compare the subject’s functional level with the normal level for the same chronologic age. The greater the discrepancy between chronologic and developmental age, the more severe the retardation. In most European and North American cultures, the Vineland Social Maturity Scale, a tool used to determine social competence, is recommended for use when appropriate.
In children, the functional level is based on sensorimotor skills, self-help skills, and socialization. In adolescents and adults, it’s based on academic skills, reasoning and judgment skills, and social skills.
Treatment
Effective management requires an interdisciplinary team approach, which continues to assist the patient and his family on primary, secondary, and tertiary levels. A primary goal is to develop the patient’s strengths. Another major goal is the development of social adaptive skills.
Children who are mentally retarded require special education and training, ideally beginning in infancy. An individualized, effective education program can optimize the quality of life for even the profoundly retarded.
The prognosis for people who are mentally retarded is related more to timing and aggressive treatment, personal motivation, training opportunities, and associated conditions than to the degree of mental retardation itself. With good support systems, many people who are mentally retarded become productive members of society. Successful management leads to independent functioning and occupational skills for some and a sheltered environment for others.
Special considerations
❑ Support the parents of a child diagnosed with mental retardation. They may be overwhelmed by caretaking and financial concerns and may have difficulty accepting and bonding with their child.
❑ Remember that a child who’s mentally retarded has all the ordinary needs of a healthy child plus those created by his disability. The child especially needs affection, acceptance, stimulation, and prudent, consistent discipline; he’s less able to cope if rejected, overprotected, or forced beyond his abilities.
❑ When caring for a hospitalized patient who’s mentally retarded, promote continuity of care by acting as a liaison for parents and other health care professionals.
❑ During hospitalization, continue training programs already in place, but remember that illness may bring on some regression.
❑ For the parents of a child who’s severely retarded, suggest ways to cope with the guilt, frustration, and exhaustion that commonly accompany caring for such a child. The parents may need an extensive teaching and discharge planning program, including physical care procedures, stress reduction techniques, support services, and referral to developmental programs. Ask the social services department to look into community resources.
❑ Teach parents how to care for the special needs of a child who’s mentally retarded. Suggest that they contact the AAMR.
❑ Teach adolescents who are retarded how to deal with physical changes and sexual maturation. Encourage them to participate in appropriate sex education classes. People who are mentally retarded may have difficulty expressing sexual concerns because of limited verbal skills.
Pictures
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Work up the potential causes of mental retardation (MR) to assist families in identifying potentially modifiable conditions or conditions that are genetic in origin so that they can receive appropriate counseling for their next child or other family relatives (Avoiding Common Pediatric Errors)
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