Intellectual Disability

Disorder

Intellectual Disability
Disorder
History )
(Mental Retardation
Plato wrote more than 2000 years ago in The Republic that no
two persons are born exactly alike; but each differ from the other by
their intellectual abilities.
Alfred Binet (1857-1911)- Started measuring these intellectual
abilities. He came with the idea about the mental age and he
understood the comparison of mental age and chronological age in
assessing the intelligence.
Terman-Retain the Binet concept of mental age and adopted
convenient index of intelligence suggested by the German
psychologist William Stern. This index is the intelligence quotient
,commonly know as the IQ. It expresses intelligence as a ratio of
mental age to chronological age.

mental age
IQ chronological ageX
100

If the MA is lower than the CA then IQ will be less than 100, If MA is

Higher than CA then the IQ will be more than 100. It is considered IQ is
below 70 as mentally retarded.
In the 19th centaury the idiot was used for people with sever intellectual
impairment, and imbecile for those with moderate impairment. When
these words carries stigma, they were replaced by the term mental
subnormality. Later it was replaced by the word mental retardation.
Today it is called Intellectual Disability Disorder.

According to IQ mental retardation divide into

Mild- (IQ 70-50)

Moderate-(IQ 49-35)
Sever- (IQ 34-20)
Profound-(IQ below 20)

 Itard was a physician in-chief at the Asylum for the

Deaf and Dumb in Paris trained the wild boy found in
Aveyron in 1801. This child was thought to have grown
up in the wild, isolated from human beings. Itard made
great efforts to train and educate the boy for 6 years but
the training had been a failure.
Seguin developed Itard methods to train and educate
mentally retarded. He devised an educational program
of physical exercises, moral instruction and graded
tasks.
1913 Mental deficiency act of England and Wales
1960 Deinstitutionalization
Residential care in small homely units came up

Aetiology of mental retardation

Chromosomal abnormalities

Downs syndrome
Klinefelters syndrome
Turners syndrome
Fragile X syndrome

Genetic abnormalities

Phenylketonuria
Galactosaemia
Tay-sachs disease
Lesch-Nyhan syndrome
Neurofibromatosis (autosomal dominance inheritance)
Tuberose sclerosis(Epiloia)-( autosomal dominant)

 Cranial malformations
Hydrocephalus
Microcephalus
Antenatal damage
Infections (rubella,cytomegalo
virus,syphilis,toxoplasmosis)
Intoxications (alcohol, Lead, certain drugs)
Physical damage (birth injury,radiation,hypoxia)
Placental dysfunction
Endocrine disorders
(hypothyroidism,hypoparathyroidism)

 Perinatal Injury
Birth asphyxia
Prematurity
Kernicterus

Post-natal damage

Injury (accidental, child abuse)

Infections (encephalitis,meningitis)

Malnutrition
Subcultural mental retardation

Effects of mental retardation on

the family
When a new born child is found to be mentally
retarded the parents are inevitably distressed.
They often experience prolonged depression,
guilt, shame, anger or anxiety. A few reject the
child, while others become over involved in its
care, sacrificing other important aspects of
family life.
Some parents get into arguments and end up in
separation or divorce but most parents get
adjusted to the situation take care of the child.

Definition of mental retardation

It is unsatisfactory to define mental retardation in
terms of intelligence quotient alone. Social criteria
must be included, since a distinction must be made
between people who can lead a normal or near normal
life and those who cannot. In practice the most useful
modern definition is probably the one used by American
Association for Mental Deficiency, which define mental
retardation as sub-average general intellectual
functioning which originated during the development
period and is associated with impairment in adaptive
behaviour.

IQ
7
0

AB

 Assessment of mental retardation.

History taking and metal state examination

Physical examination
Developmental assessment(measuring intelligence,
language, motor performance and social skills)
Behavioral assessment(ability to care himself, social
abilities, sensory motor skills and any unusual
behavior)
Psychiatric assessment(psychiatric disorder,
unrecognized epilepsy)
Differential diagnosis(delayed maturation, deafness,
blindness, childhood autism, ADD

Care of the mental retarded

Among the new concepts of care the main principle
is normalization an idea developed in
Scandinavia in the 1960s. This term refers to the
general approach of providing a pattern of life as
near normal as possible. The least handicapped are
brought up in their own homes and encouraged to
lead a almost independent lives as adults. For the
few who enter hospital the accommodation and
activities are designed to be as close as possible to
those of family life.

Mild mental retardation

(IQ 50-70)
People with mild retardation account for about
4/5 of the mentally retarded. They may have
reasonable education though they need help
with housing and employment or when under
some stress.

Moderate mental retardation

(IQ 35-49)
People in this group account for about 12% of
the mentally retarded. Most of them can talk
or at least learn to communicate.

Severe mental retardation

(IQ20-34)
In the pre-school years their development is
usually greatly slowed. Eventually many of
them can be trained to look after them selves
under close supervision and to communicate
in a simple way.

Profound mental retardation

(IQ below 20)
People in this group account for less than 1%
of mentally retarded. They may need care in a
institution.

Treatments
It has been clearly shown that early start of training
programs are helpful. Therefore parents can start self
care and living skill programs at home. Then send the
child to pre- school early and continue educational
programs.
Later the child may enter school. Some need special
class in normal school. Those who find difficult to follow
may enter school for mentally retarded.
Once they complete the education they may follow
vocational training Centre.
Types of behavior therapy( instructions, coaching,
prompting, modeling, shaping, rewarding, role-play,
seclusion)

Prevention of mental
retardation(intellectual disability
disorder)

Genetic counselling
Prenatal care
Advice on diet alcohol and smoking

Providing immunization against rubella

Amniocentesis, fetoscopy and ultra sound scanning
Detection and treatment of rhesus incompatibility
Special care for mothers with diabetes mellitus

 Good obstetric care for mother

Post natal care
All infants should be tested for
phenylketonuria, hypothyroidism and
galactosaemia
Special care for pre-mature and low birth
weight infants can prevent mental retardation
Education and supporting the mothers could
prevent sub-cultural mental retardation

Question
Why Psychiatric disorders are common in
intellectual disability disordered people(mental
retardation)?