MENTAL RETARDATION
Mental Subnormality
The term mental sub normally is used to ‘denote a condition of retarded, incomplete or abnormal
mental development present at birth or early childhood, and characterized mainly by limited
intelligence. Other terms used to describe mental sub normality are mental Retardation, Mental
Handicap and Mentally Challenged. Mental retardation varies in severity, mild, moderate severe and
profound. These categories are based on the functioning level of the individual.
1. Mild Mental Retardation (IQ 50-75). (MORON)
Appoximately 85% of people with mental retardation are categorized as mild. The intelligence quotient
(IQ) score ranges from 50-75. They can become fairly self-sufficient and in some cases live
independently, with community and social support.
Moderate Mental Retardation (IMBECILE)
About 10% of the mentally retarded population is considered moderately retarded. Moderately
retarded individuals have IQ score ranging from 35-55. These children are considered trainable but only
simple tasks can be accomplished with moderate supervision Communication skills do not develop
adequately and social isolation results. Occupational and self-reliance task are achieved only with
supervision.
Severe Mental Retardation
Severely retarded individuals have IQ scores of 20-40. About 3-4% of the mentally retarded population is
severely retarded. Speech and motor development are poor. Self-care may be possible through
behavioral training. An institutional setting is usually required for management.
Profound Mental Retardation
Only 1-2 % of the mentally retarded population is classified as profoundly retarded. Profound retarded
individuals have IQ score under 20. Language may not exist and motor skills are severely impaired.
Lifelong constant supervision and nursing care required. They are totally dependent on others for
survival. All people with mental retardation may demonstrate low frustration tolerance, hyperactivity,
aggression, self-injurious behaviour, and affective instability.
AETIOLOGY/CAUSES OF MENTAL RETARDATION
In about 35% of cases, the cause of mental retardation cannot be found, Biological and environmental
factors can cause mental retardation.
Pre-natal -Before Conception
About 5% of mental retardation is caused by hereditary factors. Mental retardation may be caused by an
inherited abnormality of the genes as in Huntington’s chorea Heredity may also be chromosomal
abnormality eg. Trisomy 21
Age of mother: very old on very young mothers have risk of having subnormal children Age of mother
should be over 35years.
Mental disorder in one or both parents
DURING CONCEPTION
Peri-Natal Causes (During birth)
Obstetric difficulties
Asphyxia neonatorium
Birth injuries
Low birth weight
Prolong or difficult birth
Cord prolapse
Post-Natal Causes (especially within the first five years of life)
Neonatal diseases
Infections
Accidental trauma
Poisoning from lead found in paint and mercury
Social causes – environmental deprivation i.e. deprived parent on isolation for a long time
SOME SPECIFIC FORMS OF SUBNORMALITY
A. DOWN’S SNYDROME (MONGOLISM, TRISOMY 21. TRISOMY 21)
This condition was first described by Langdon-Down in 1887.
In Down’s syndrome because of a biological error around the time of conception the cells come to have
one extra chromosome i.e. 47 instead of 46. The presence of an extra chromosome in the cells
interferes with the normal development of the brain, leading to mental retardation. The individual
inherits an extra chromosome on the 21st pair
It is often possible to recognize people with down’s syndrome by the following features
Broad nose with poorly developed bridge (flat)
Small round skull with its back flattened
Enlarged tongue which protrudes out of the mouth
Has only one palmer crease instead of two
Short limbs, short fingers with squared palm
Short and thick neck
Prone to respiratory tract infection congenital heart disease
Alert, happy affectionate person and lover of music IQ 25-50
B. KLINEFELTER’S SYNDROME (XXY)
The affected person inherit XXY chromosome. The syndrome is usually recognized at adolescence.
Clinical features are:
Girlish voice
Testicular atrophy
Tall angular-build
Gynaecomatia
Prone to mental illness
C. TURNER’S SYNDROME (XO)
- Child inherits XO chromosome clinical features
-Dwarfism
D. PHENYLKETONURIA (PKU)
-enzyme - This is an inherited metabolic disorder in which there is the absence of the phenylalanine
hydroxylase, essential for the oxidation of the protein, phenylalanine into tyroxine. Phenylalanine thus
accumulate in the blood stream and eventually damages the brain. Phenylalanine is excreted through
the urine
Clinical Features
-Child is normal at birth
-Signs of slow growth begin to show in infancy
-Epilepsy is common
-Overactive and twitchy mannerisms
TREATMENT
-Early detection through Screening of all newborns
-Special diet – low phenylalanine diet
-Phynylalanine hydroxylase preparation are administered
E. KERNICTERUS
-Condition results from rhesus incompatibility (a Rh-ve woman with Rh+ve foetus from a Rh+ve husband
Clinical Features
-Severe Jaundice. -Twitching. -Fits. -Vomiting. -Deafness. -Epilepsy
COMMON HEALTH PROBLEMS ASSOCIATED WITH MENTAL RETARDATION
-Restlessness (continuously moving around; unable to sit at one place)
-Poor concentration. -Impulsiveness. -Temper tantrums. -Irritability. -Crying. -Head banging. -Repetitive
rocking
