A NUMBER of established and standardized developmental screening procedures are available for children suspected of mental retardation. Confusing results are not uncommon since there are several conditions that may be mistaken for mental retardation.
They include: autism, attention deficit disorders, cerebral palsy, language and speech disorders, convulsive disorders, significant visual or hearing impairment and degenerative disorders.
A more definitive evaluation maybe required. This is better accomplished by a child psychologist who has more experience with children.
Sometimes the results are less straightforward and further referral to other medical specialists maybe needed. The specialists may include developmental pediatrics, neurology, genetics, ENT or ophthalmology.
There is no specific laboratory test for mental retardation. Routine laboratory tests are not helpful. Testing will depend on individual situation based on historical data and/or findings on physical examinations. Commonly ordered tests are genetic testing, metabolic tests, thyroid function tests, head MRI, electroencephalography and audiologic testing. Other tests are performed as indicated.
The most challenging problem arises when there is no identifiable cause on a child with mental retardation. The health care provider will have difficulty answering questions from parents who desperately need answers. Questions like, "What is the cause of my child's problem?", "Will this happen again?", "What is the treatment?", "Will my child be normal?", "What is the long-term outcome?"
Long-term prognosis will depend on the cause; the degree of retardation; the associated medical and developmental problems; family, school and community support. In general, individuals with mental retardation can live to adulthood and old age except those who are severely affected and those with specific medical risks.
There is no specific prevention for mental retardation. Prevention of some underlying causes is possible like early detection of metabolic disorders, immunization, protection against head injuries, prevention against neonatal asphyxia, and avoidance of alcohol and drugs during pregnancy.
Pediatric care of a mentally retarded is similar to other pediatric population such as acute pediatric care, preventive programs, supervision of general health needs with particular attention to oral health, assessment of visual and hearing problems, growth monitoring and maintenance of good health practices.
As a group, mentally retarded children have more medical complaints mostly from associated problems (seizure disorders, cerebral palsy, feeding disorders, increased incidence of congenital heart disease, autistic spectrum disorders, disorders of behavior and emotions) than the average pediatric population.
For example, the principles of treatment in the control of seizure disorders in mentally retarded are the same as in general population. However, severe and intractable seizures are more commonly found in the retarded population.
Complete control sometimes may not be possible as the seizures may require too much sedation, which may prevent the child from functioning between seizure episodes. Protection against injuries should be provided in retarded children with intractable seizures.
Retardates experience similar types of mental health problems as do individuals with normal intelligence. However, because of the presence of associated problems and the severity of retardation, behavior disorders are more frequently encountered, especially in the severely retarded children.
In this situation, problem behaviors are difficult to recognize because of the retardate's limited capacity to understand and communicate their feeling or complaints, if they have some medical problems like headaches, earaches or abdominal pains.
Severely retarded children are likely to display serious problem behaviors like aggressiveness, destructiveness to himself or his environment, hyperactivity and inattentiveness. Behavior management programs include: behavioral therapy, use of medications and psychotherapy. The ultimate goal is to help the child reach his/her full potentials.
Social and educational programs are important in promoting the retarded child's optimal adaptation and emotional well-being. They include: nursery schools, recreational programs, special education programs and others. The goal is to let the retarded individuals participate in as many activities as possible with their limited capabilities. (PVI)
