2mental Retardation

8/14/2019 2mental Retardation

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MentalMental

Retardation(MR)Retardation(MR)

Department of psychology

The first affiliated hospital of ZZU

Huirong guo


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TerminologyTerminology

In ICD-10 and DSM- the term mental

retardation denotes intellectual impairment

starting early in life (as distinct fromdementia !hich is intellectual impairment

de"eloping later in life )

#ther terms of this condition include mental

deficiency mental su$normality mental

handicap and most recently learning

difficulties%


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&lthough the central feature is intellectual

impairment the definition of mental retardation

should include social criteria for the practical

purpose of distinguishing $et!een people !hocan and those !ho cannot lead a near-normal

life%

Thus in DSM- the definition of mental

retardation includes not only intellectual

impairment $ut also the phrase' !ith concurrent

deficits and impairments in adapti"e $eha"ior

taing into account the person's age'


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Su$groups of mental retardation are

recognied according to the degree of

impairment* mild (I+ ,0-0)

moderate (I+ .,-/)

se"ere (I+ 0-./)

and profound (I+ $elo! 0)%


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2pidemiology2pidemiology &mong the population aged 1,-1the pre"alence

of moderate and se"ere mental retardation isa$out .%0 to /%0 per thousand

The pre"alence of mental disorder among thementally retarded increase !ith the se"erity ofthe retardation

&mong people !ith mild mental retardation the

pre"alence of mental disorder is similar to thatamong people of normal intelligence $ut amongpeople !ith se"ere retardation it is greater


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Clinical features of MRClinical features of MR

the characteristic feature is lo! performance

of all inds of intellectual functioning

including learning short-term memory theuse of concepts and pro$lem sol"ing%

Sometimes one specific function is impaired

more than the rest for e3ample the use of

language any of the common $eha"ioral pro$lems of

childhood


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Types of retardationTypes of retardation

Mild

IQ50-70

80 percent of all retarded

pecific causes uncommon

!any need practical help and education

"e# need special psychiatric or social ser$ices


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Moderate

IQ %5-&'

() per cent of all retarded

!ost can manage some independent acti$ities

*e+uire special education, occupation, and

super$ision


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Se"ere

IQ )0-%&

7 per cent of all retarded

pecific causes usual

ocial sills se$erely limited

*e+uire close super$ision and much practicalhelp


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4rofound

IQ .elo# )0

( per cent of all retarded

pecific causes usual

/ery se$erely disa.led

hysical pro.lems usual

/ery poor self-care


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4hysical disorders4hysical disorders

&mong the se"erely and profoundly retarded

most ha"e physical pro$lems such as sensory

or motor disa$ilities or epilepsy% Disorders ofhearing or "ision are important additional

o$stacles% Motor disa$ilities are fre5uent

including spasticity ata3ia and athetosis


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4sychiatric disorder4sychiatric disorder

&ll inds of psychiatric disorder can occur in

the mentally retarded%

Diagnosis is often difficult $ecause symptomsmay $e modified $y lo! intelligence


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4sychiatric disorder4sychiatric disorder

Schiophrenia

&ffecti"e disorder

&d6ustment disorder and neurosis

4ersonality disorder

#rganic psychiatric disorder

#"eracti"ity and autistic $eha"ior Se3ual pro$lems


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2ffects on the family2ffects on the family

They often e3perience prolonged depression!ith guilt shame or anger

& fe! parents re6ect the child !hile others$ecome o"erin"ol"ed in caring for the child to

the detriment of their other children Most parents e"entually achie"e a satisfactory

ad6ustment although they are still tempted too"erindulge the child

9o!e"er !ell they ad6ust psychologicallyparents are faced !ith the prospect of prolongedhard !or and social pro$lems% If the child alsohas a physical handicap these pro$lems areincreased%


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&etiology&etiology

Mild mental retardation is usually due to acom$ination of genetic and ad"erseen"ironment factors

Se"ere mental retardation is usually due topathological conditions of !hich most can $ediagnosed in life and a$out t!o thirds $efore$irth%

:oth mild and se"ere retardation are morecommon in the lo!er social classes possi$ly$ecause of less effecti"e pre"enti"e measures


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&etiology&etiology

;eneral causes

much mild mental retardation represents the

lo!er end of the normal distur$ance ofintelligence !hich is mainly determined $y

polygenic inheritance% Specific genetic

a$normalities are responsi$le for many of the

meta$olic and other disorders that causesse"ere retardation% Some of these causes are

discussed further $elo!


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&etiology&etiology

Social factors* lo! I+ is associated !ith lo!ersocial class po"erty poor housing and anunsta$le family en"ironment

&ntenatal damage may $e caused $y intra-uterine infection or to3ic su$stances%

4erinatal damage* the causes include $irth

in6ury ernicterus and intra"entricularhemorrhage% Clinically recognia$le $rainin6uries at $irth account for a$out 10 per centof mental retardation%


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&etiology&etiology

4ost-natal damage* may $e due to in6ury

infections and lead into3ication

Malnutrition is a common cause inde"eloping countries though much less

common in de"eloped countries


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Specific causesSpecific causes

;enetic causes

dominant conditions* neurofi$romatosis and

tu$erose sclerosis are e3amples of these rareconditions

recessi"e conditions* this is the largest group

of specific disorders and includes most of the

inherited meta$olic conditions such as

phenyletonuria homocystinuria and

galactosaemia


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Specific causesSpecific causes chromosome a$normalities: the most

common chromosome a$normality is Do!n's

syndrome% &$normalities in the num$er of

se3 chromosomes such as


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2tiology of $eha"ior pro$lems2tiology of $eha"ior pro$lems

and psychiatric disorderand psychiatric disorder

genetic organic psychological and social

The genetic causes of psychiatric disorderamongst the mentally retarded seem to

unconnected !ith the genetic causes of

retardation and to $e the same as those

causing the corresponding psychiatric

disorder in people of normal intelligence%


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and psychiatric disorderand psychiatric disorder #rganic $rain pathology is a common cause

of $eha"ior pro$lems in the most se"eralretarded people% There is a particularly closeassociation $et!een epilepsy and $eha"iordisorder especially hyperinetic $eha"ior

4sychological causes account for some of the$eha"ioral pro$lems of mentally retardedpeople% These causes include frustrationassociated !ith communication difficultyina$ility to ac5uire social sills andeducational failure%


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and psychiatric disorderand psychiatric disorder Social factors such as family tensions or

$erea"ement are important causes of

$eha"ior pro$lems in mentally retardedpeople 6ust as in people of normal

intelligence% &n o"erstimulating en"ironment

may cause $eha"ior pro$lems and an

understimulating one may lead to !ithdra!aland self-stimulation


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&ssessment&ssessment

Se"ere mental retardation can usually

diagnosed in infancy as it is often associated

!ith physical a$normalities or delayed motorde"elopment%

The diagnosis of less se"ere mental

retardation is more difficult $ecause it is

$ased on delays in psychological de"elopment


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9istory taing

4hysical e3amination

:eha"ioral assessment


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De"elopmental testing

#"erall assessment

Ser"ices for the mentally retarded


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Ser"ices for mentally retardedSer"ices for mentally retarded

4re"ention

;enetic counseling

2arly detection &nte-natal screening

&nte-natal o$stetric care

4ost-natal screening &ssessment and periodic reassessment


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Ser"ices for mentally retardedSer"ices for mentally retarded

&d"ice and support to families

4ractical help for families

9ealth care Respite admission to hospital

Special education training and occupation

Residential accommodation ;eneral medical ser"ices


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Treatment of psychiatric disorderin the mentally retarded

similar to that of the same disorder in apatient of normal intelligence

4articular care is needed


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