2. DEFINITION MENTAL RETARDATION.
AAMD and DSM-1V defines mental retardation as significantly sub
average general intellectual functioning resulting in or associated with
concurrent impairment in adaptive behavior and manifest during the
developmental period –that is before the age of 18Definition
3. CLASSIFICATION
Mild mental retardation IQ level 50-55 to approx 70.
Moderate retardation IQ level 35-40 to 50-55.
Severe mental retardation IQ level 20-25 to 35-40.
Profound mental retardation IQ level below 20-25.
Mental retardation severity unspecified: when there is a
strong presumption of mental retardation but the person’s
intelligence is untestable by standard test.
4. EFFECTS OF MENTAL RETARDATION ON FAMILY
Distress and feeling of rejection
Depression guilt shame or anger
Rejection of child
Overindulgence
Social problems
Marital disharmony
Burden of care for their child
Dissatisfaction among medical and social services
5. CLINICAL PICTURE OF MENTALLY RETARDED:
Mouth –small mouth and teeth, furrowed tongue, high arched
palate.
Eyes-oblique palpebral fissures, epicanthic folds.
Head –flat occiput
Hands –short and broad, curved fifth finger ,single transverse
crease
Joints –hyper extensibility or hyper flexibility,hypotonia poor
Moro reflex
Others –CHD especially ASD,VSD PDA and arterioventricalar
communes in about 40% cases
Burchfield spots (whitish spacklings on the iris)
Flat facieses
Small dysplastic ear
Impaired hearing and intestinal abnormalities(specially
duodenal obstruction)
Hypothyroidism
Epilepsy
Ocular disturbances
12. CLINICAL FEATURES
The essential feature of Expressive language
disorder is a specific deficit in the development of
Expressive language abilities. Nonverbal
intelligence and receptive language development
are not affected.
13. MIXED RECEPTIVE
Etiology
Genetic Tendency
Left hemispheric dysfunction
Socio economic factors like large family, lower
social class, late birth order and environmental
deprivation
14. Clinical features-developmental type
Vocabulary comprehension difficulties occur with
prepositions, adjectives, adverbs and pronouns
Grammatical comprehension deficits occur with
misinterpretation of grammatical units or
morphemes(such as noun plurals, verb. tenses etc)
Pragmatic comprehension deficits are manifested by
abnormalities with conversational skills such as turn
taking, maintaining a topic and being polite. There is also
a delay in speech-language mile stones(babbling, saying
the I word, the I sentences etc)
15. Acquired type-the effects of
cerebral trauma vary in
severity, locus and extent.
Right hemisphere damage is
predictive of comprehension
impairment, unilateral left
hemisphere lesion results in
expressive or phonological
problems
16. DEVELOPMENTAL READING
DISORDERS
Etiology
Unknown
Prenatal /postnatal factors such as prematurity, low
birth weight, toxemia of
pregnancy, hyperbilirubinemia, recurrent
otitis, meningitis, encephalitis and anemia.
17. Clinical features
Inaccurate reading, slow reading and poor reading
comprehension
Word recognition is poor
The misreading may be distortions, substitutions or
omissions of words
Course
Recognition is at 5 yrs of age. The disorder tends to
improve overtime with or without treatment but it is very
slow and never complete.
18. Treatment
Remedial education-direct instruction in reading ,practice
with letter sound associations, word recognition tasks
and reading comprehension
Medical approaches include stimulants,anti-anxiety drugs
and special diets
Psychosocial approaches are supportive
psychotherapy, parent guidance and training, social skills
training, relaxation therapy and behavior modification
approaches.
19. DEVELOPMENTAL ARITHMETIC
DISORDER
It is impairment in the development of arithmetical
or mathematical skills that is sufficiently serious to
interfere with academic achievement of daily living.
The impairment cannot be explained by the
persons measured intelligence levels, educational
background, visual acquity.
Etiology –is unknown
20. Clinical features
Symptoms include difficulties in performing basic
arithmetical operations, memorizing numerical
facts, following sequences of mathematical
steps, counting objects and multiplying.
Attention symptoms include inaccurate copying of
numbers, omitting digits, decimals or symbols when
writing answers, forgetting to add in carried numbers
during addition and addition and filing to note arithmetical
signs.
Course
Mathematical difficulties’ may be apparent in the
kindergarten stage but a diagnosis can be made only
when the child comes to the 2nd or 3rd grade.
21. Treatment
Various options are special classroom placement,
supplemental remedial tutoring, perceptual skills training
(focusing on skills such as matching, sorting and
arranging objects) diagnostic –prescriptive teaching (i.e.
focusing on actual mathematics deficits) and cognitive –
developmental teaching (i.e. where the teacher facilitates
learning through areas of cognitive strength in the child.
22. ARTICULATION DISORDER
(PHONOLOGICAL DISORDER)
Etiology
Causes can be hearing impairment, structural
deficits of the oral peripheral speech mechanism
(cleft palate), neurological disorders (cerebral
palsy) cognitive limitations (M.R) and psychosocial
deprivation
23. DIAGNOSIS AND CLINICAL FEATURES
Speech sound disorders are characterized by
omissions, substitutions and distortions of speech
sounds. In phonological disorder, the speech
sounds that are most frequently misarticulated are
those that tend to be acquired last in the normal
language acquisition process (e.g. sounds
represented by the letters S, Z, sh, ch, dg, th, dz
and r)
24. TREATMENT
1. A child needs speech therapy if
Speech intelligibility is poor
The child is older than 8 years
The articulation problem is apparently contributing to or causing
problems with peers self image or learning.
The articulation impairment is severe
2. In addition, peer relationships, school behaviors and learning
process also has to be monitored
26. PERVASIVE DEVELOPMENTAL
DISORDER:
Autistic disorder:
Etiology:
Genetic
Neurological
Metabolic
Immunologic
Environmental factors
Complications from birth
Abnormality in the structure and functioning of the
brain.
28. Abnormal sleeping patterns
Repeatitive, restricted, stereotypic patterns of behavior
Do not actively indulge in normal play
Fascinated with revolving objects like revolving
fans,opening and clocing the door ,constantly turning the
light on and off.
Approximately 8o% of individuals with autistic disorder
have some degree of mental retardation,50% have
severe or profound and 30% have mild mental
retardation
Affects the cognitive areas such as judgment, insight and
reasoning
Communication problems and both verbal and non verbal
areas are affected
29. Prognosis:
There is no cure for autism evidence demonstrate that
early intense educational interventions using highly
structured progrrammes helps the clients to achieve the
highest level of functioning in social, communication and
cognitive skills.
31. ATTENTION DEFICIT AND DISRUPTIVE
BEHAVIOUR DISORDER:
Attention deficit hyperactivity disorder:
It is a disorder characterized by
inattentiveness, over activity and impulsiveness .it
is a common disorder especially in boys and
probably accounts for more referrals of childhood
disorder than any other disorder (Hetchman, 2005)
32. ONSET AND CLINICAL COURSE:
ETIOLOGY:
Environmental toxins
Prenatal influences
Hereditary
Damage to brain structure and function
Prenatal exposure to alcohol ,tobacco and
lead
Severe malnutrition
Decreased metabolism in the frontal lobe
Decreased blood perfusion to the frontal
cortex
34. CONDUCT DISORDER:
It is characterized by persistent antisocial behavior
in children and adolescents that significantly
impairs their ability to function in social, academic
or occupational areas.
35. SYMPTOMS:
Symptoms are clustered in four main areas:
Aggression to people and animals.
Destruction of property
Deceitfulness and theft
Serious violation of rules
36. ONSET AND CLINICAL COURSE:
CLASSIFICATON OF CONDUCT DISORDER:
MILD: some conduct problems relatively minor
harms
MODERATE: number of conduct problems
increases as the harm to others also
SEVERE: person has many conduct problems and
considerable harm to others
37. ETIOLOGY:
Genetic vulnerability
environmental adversity
poor parenting
low academic achievement
poor peer relationship
low self esteem
resilience
poor family functioning
marital discord
family history of substance abuse
38. TREATMENT:
Parenting education
Social skill training
Improving peer relationship
Attempts to improve academic performance
Family therapy
Individual therapy
Conflict resolution
Anger management
Teaching social skills
Antipsychotic medication with therapy if the patient
is very violent
39. OPPOSITIONAL DEFIANT DISORDERS:
This disorder consists of an enduring pattern of
uncooperative, defiant and hostile behavior towards
authority figures without major antisocial violation.
It can only be diagnosed when the behavior is
intense and more frequent found in about 5% o0f
population and equal in both the males and females
causes dysfunction in social, academic and work
situation and 25% of them develop conduct
disorder and the treatment is as same as conduct
disorder.
40. FEEDING AND EATING DISORDER:
The disorder of feeding and eating included in this
category are persistent in nature and not explained
by underlying medical condition:
PICA:
RUMINATION DISORDER:
FEEDING DISORDER:
41. TIC DISORDER:
A tic is a
sudden, rapid, recurrent, nonrhythmic, stereotyped
motor movement or vocalization. Tics can be
suppressed but not indefinitely a stress exarbates
tic which diminishes during sleep and when the
person is engaged in an absorbing activity.
TOURETT’ S DISORDER:
CHRONIC MOTOR OR TIC DISORDER:
43. ENURESIS
Definition: Enuresis is defined as the repeated
voiding of urine into clothes or bed, whether the
voiding is involuntary or intentional. The child’s
chronological or developmental age must be at
least 5 years. (DSM IV).
44. Types:
Based on the Onset:
Primary enuresis:
Secondary enuresis:
Based on the time:
Nocturnal enuresis:
Diurnal enuresis:
Both diurnal and nocturnal
When it occurs both the times primary and nocturnal
types of enuresis are more common than the others.
45. ETIOLOGY
Genetic factor
Disorder of genitourinary tractAssociation with UTI
Urinary tract obstruction
Bladder size and functions
Developmental changes in the bladder neck
Urinary circadian rhythm
Disorders of CNS
Depth of sleep
Epilepsy and EEG abnormalities
Neuroleptic-induced enuresis-for e.g. thiothixene and
thioridazine.incontinence with phenothiazine induced catatonic
states and stress incontinence in patients receiving
chlorpromazine
Developmental delays
Enuresis is a disorder arising from disturbances in early life.
46. i) Toilet training
ii) Stressful life events in early childhood
Diagnosis
Criteria for non-organic enuresis
The child’s chronological and mental age is at least 5
years
Involuntary or intentional aged under 7 years and at least
once a month in children aged 7 years or more
The enuresis is not a consequence of epileptic attack or
of neurological incontinence and are not a direct
consequence of structural abnormalities of the UT or any
other psychiatric condition
There is no evidence of any other psychiatric disorders
that meets the criteria for other ICD-10 categories
Duration of the disorder is at least 3 months
47. COURSE AND PROGNOSIS
TREATMENT
1. Behavioral interventions
2. Retention control training ( RCT)
3. Dry bed training
Drug treatment
Psychotherapy
48. ENCOPRESIS:
Types
1. Primary type-where toilet training has never been
achieved
2. Secondary type-where Encopresis emerges
often a period of fecal continence. This type
typically occurs between the ages of 4 &8
49. Etiology
Inadequate, inconsistent toilet training
Ineffective and inefficient sphincter control
Neuro developmental problems-easy distractibility ,short
attention, span, low frustration tolerance, hyperactivity etc
Fear of toilet
Emotional reasons-fear, anxiety, anger etc
Sibling rivalry
Maturational lag
Mental retardation
Childhood schizophrenia
Autistic disorder
