
In young children, Mental retardation is often missed by clinicians. The condition is present in 2 to 3 percent of the population, either as an isolated finding or as part of a syndrome or broader disorder. Causes of mental retardation are environmental factors and genetic. In at least 30 to 50 percent of cases, physicians are unable to determine etiology . Diagnosis is highly dependent on a comprehensive personal despite thorough evaluation and family medical history, a complete physical examination and a careful developmental assessment of the child. These will guide appropriate evaluations and referrals to provide genetic counseling, resources for the family and early intervention programs for the child. The family physician is encouraged to continue regular follow-up visits with the child to facilitate a smooth transition to adolescence and young adulthood.
The diagnosis of mental retardation in young children is frequently missed. The three most common errors made by clinicians who overlook the possibility of mental retardation are (1) concluding that a child does not “look” retarded, (2) assuming that a child who is ambulatory is unlikely to be retarded and, (3) if retardation is actually considered, concluding that it is not possible to test young children.1
Developmental Characteristics Related to Level of Mental Retardation (DSM-IV Criteria)
| MILD RETARDATION | MODERATE RETARDATION | SEVERE RETARDATION | PROFOUND RETARDATION |
|---|---|---|---|
| 75% to 90% of all cases of retardation | ~10% to 25% of all cases of retardation | ~10% to 25% of all cases of retardation | ~10% to 25% of all cases of retardation |
| Function at one half to two thirds of CA (IQ: 50 to 70) | Function at one third to one half of CA (IQ: 35 to 49) | Function at one fifth to one third of CA (IQ: 20 to 34) | Function at < one fifth of CA (IQ: < 20) |
| Slow in all areas | Noticeable delays, especially in speech | Marked and obvious delays; may walk late | Marked delays in all areas |
| May have no unusual physical signs | May have some unusual physical signs | Little or no communication skills but may have some understanding of speech and show some response | Congenital abnormalities often present |
| Can acquire practical skills | Can learn simple communication | May be taught daily routines and repetitive activities | Need close supervision |
| Useful reading and math skills up to grades 3 to 6 level | Can learn elementary health and safety habits | May be trained in simple self-care | Often need attendant care |
| Can conform socially | Can participate in simple activities and self-care | Need direction and supervision | May respond to regular physical activity and social stimulation |
| Can acquire vocational skills for self-maintenance | Can perform tasks in sheltered conditions | — | Not capable of self-care |
| Integrated into general society | Can travel alone to familiar places | — | — |
note: Additional problems with vision, hearing or speech, congenital abnormalities, seizures, emotional problems or cerebral palsy may be present.
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