Bns 3 Exam - Mental Retardation

Front 1

Criteria for diagnosis of MR

Back 1

◦IQ less than 70
◦Impaired adaptive functioning

Front 2

4 levels of MD

Back 2

◦ 50-55 to 70 = Mild MR
◦ 35-40 to 50-55 = Moderate MR
◦ 20-25 to 35-40 = Severe MR
◦ < 20-25 = Profound MR

Front 3

is Borderline Intellectual Functioning

Back 3

◦ IQ of 70-84
V code on Axis II

Front 4

Characteristics of Mild MR

Back 4

: 85% of total MR cases
◦ Achieve 6th grade academic skills
◦ Adults require minimal self support, employable but need supervision

Front 5

Characteristics of Moderate MR

Back 5

: 10% of total MR cases
◦ Achieve 2nd grade academic skills
◦ Can bathe, make simple meals.

Front 6

Characteristics of Severe MR

Back 6

3-4% all MR
◦ Very impaired, can read sight survival words

Front 7

Characteristics of Profound MR

Back 7

1-2% all MR
◦ Impaired sensorimotor, institutional or highly supervised care required.

Front 8

MR Diagnosis
 2 steps to MR Diagnosis:

Back 8

1. Diagnose Syndrome
◦ IQ test
◦ Adaptive Functioning (interview and Vineland Adaptive Behavior Scale
◦ Behavioral and psychiatric disturbances
2. Diagnose the Cause
Complete medical work up

Front 9

Cause of MR

Back 9

 35% of MR has genetic cause
 10% of MR has an associated physical malformation

Front 10

Syndrome diagnosis: IQ tests

Back 10

◦ Bayley Scale for Infant Development
 (1-42 months; tests developmental delay)
◦ Wechsler Intelligence Scale for Children (WISC)
 6-17 yo, 10 subtests
◦ WPPSSI
 2.5 to 7.25 yo, 14 subtests
◦ Leiter International Performance Scale measures nonverbal IQ
 2-20 yo
 Requires NO spoken language to take the test or give directions – used in child with communication disorders, hearing impaired
 May also use the Test of Nonverbal Intelligence (TONI) or Peabody Picture Vocabulary Test (PPVT)

Front 11

What IQ test?
2.5 to 7.25 yo, 14 subtests

Back 11

WPPSSI

Front 12

What IQ test?
(1-42 months; tests developmental delay)

Back 12

Bayley Scale for Infant Development

Front 13

What IQ test?
2-20 yo
Requires NO spoken language to take the test or give directions – used in child with communication disorders, hearing impaired
 May also use the Test of Nonverbal Intelligence (TONI) or Peabody Picture Vocabulary Test (PPVT)

Back 13

Leiter International Performance Scale measures nonverbal IQ

Front 14

What IQ test?
6-17 yo, 10 subtests

Back 14

Wechsler Intelligence Scale for Children (WISC)

Front 15

Syndrome Dx: Adaptive Skills

Back 15

 Vineland Adaptive Behavior Scale: Measures Self Sufficiency in MR, Developmental Delay, Autism, ADHD
◦ 2 Formats: Semistructured interview with caregiver or survey report of teacher
◦ Subtests:
 Communication
 Socialization
 Daily Living Skills
 Motor Skills
 Maladaptive Behavior (both internalizing and externalizing)

Front 16

What should you ALWAYS ASSUME with trauma in MR patients?****

Back 16

Abuse by caregivers!!!!!!!!

Front 17

Syndrome Dx: Behavioral/Pscyhiatric Issues: still at the 1st step.

Back 17

 MR Comorbidities are very HIGH
◦ 30-70% of MR individuals have comorbid psychiatric diagnoses
◦ 4-6x that of general population!
◦ Why? Disturbed brain development leads to psychiatric, and behavioral disturbances in addition to intellectual.
 MR patients come to psychiatrist’s recognition because of emotional/behavioral disturbances.
◦ Objective>>>subjective report to look at
◦ Focus on change from baseline
◦ Spend more time and adopt an informal interview style
 Always consider TRAUMA/ABUSE since this population is at HIGH risk of abuse by caregivers.

Front 18

Common MR Comorbidities

Back 18

 Pervasive Developmental Disorder
 ADHD
 Pica, Rumination Disorders: chew, regeritate then chew again
 Tic Disorders
 Mood Disorders (MDD, BPAD):
 Anxiety Disorders (OCD, PTSD): high risk for abuse
 Behavioral Dyscontrol:
◦ Self injury (head banging, self biting)
◦ Aggression towards others (physical or sexual)

Front 19

MR from Fragile X___

Back 19

ADHD in 80%

Front 20

MR from Prader Willi:

Back 20

OCD and MDD: chromosome 15.

Front 21

MR from Williams

Back 21

ADHD, anxiety, depression: happy puppet syndrome

Front 22

MR from Downs

Back 22

Dementia in >40yo, depression

Front 23

MR Differential Diagnoses

Back 23

◦ Pervasive Developmental Disorder
◦ Learning Disorder
◦ Communication Disorder
◦ Borderline Intellectual Function

Front 24

What it the most common hereditary cause of MR?

Back 24

Fragile X***

Front 25

What it the most common preventable cause of MR

Back 25

Fetal Alcohol Syndrome **

Front 26

What it the most common Chromosomal cause of MR

Back 26

Down’s (Trisomy 21)***

Front 27

What is the most important physical exam for MR?

Back 27

****hearing and vision test

Front 28

Most common causes MR

Back 28

 Downs Syndrome
◦ 1 in 600 births
◦ Most common genetic/chromosomal cause of MR (not inherited, occurs during meiosis)
 Fragile X Syndrome
◦ Most common inherited cause of MR CGG repeat is amplified in successive generations, >200 repeats = disease
 Fetal Alcohol Syndrome
◦ 1:750 to 1:5000 births, depending on region
◦ Most common preventable cause of MR
 After the age 35.

Front 29

Clinical Management of MR in early intervention?

Back 29

 Early intervention to reduce morbidity
◦ Normalization and community care
◦ Special classes/programs in mainstream school
◦ Caregivers actively involved in treatment planning

Front 30

IDEA (Individuals with Disabilities Education Act)

Back 30

◦ Entitles child to full range of diagnostic, educational, and supportive services from 0-21 years old if MR
◦ Free public education in least restrictive environment

Front 31

 Psychiatric Treatment

Back 31

◦ Treat psychiatric comorbidities
◦ Behavior intervention is always first line. Train parents, caregivers, school personnel in behavioral modification

Front 32

Medication and Guidelines and Precautions

Back 32

◦ Comprehensive assessment unless emergency
◦ Clear goals with focus on target signs/symptoms.
◦ Risk/Benefit ratio explained to caregivers i.e., may help target sx but hurt some other area of functioning.
◦ Obtain informed consent from parent/guardian.
◦ Anticholinergic and benzodiazepines may cause paradoxical agitation.

Front 33

Mesd for MR

Back 33

 Meds used: Depend on target sx, SE profile. All are at our disposal. Naltrexone has been used for self injurious behavior to short circuit reward (DA) pathway.
Medication: treat low and slow

Front 34

In Fragile X Syndrome what repeat cause the problem?

Back 34

CGG

Front 35

When is Down syndrome occurs?

Back 35

not inherited, happens during meiosis