Mental Behnderung (Intellectual Disability)

Mental retardation is characterized by significantly below average intelligence (IQ <70-75) with impairment of at least two of the following skills: communication, self-care, use of community facilities, self-determination, health and personal safety. Treatment involves promotion, family counseling and social support.

Mental retardation is regarded as a disease of the nervous system. Neurodevelopmental disorders are neurologically based conditions that occur early in childhood, usually affecting before starting school and the development of personal, social, academic and / or professional functioning. They usually include difficulty acquiring, in maintaining or application of specific skills or of rows of information. Disturbances in the development of the nervous system can result in dysfunction of attention, memory, perception, language, problem solving and social interaction. Other common neurologischemn developmental disorders attention deficit hyperactivity disorder, autism spectrum disorders and learning disorders include, for example, Dyslexia)

Mental retardation is characterized by significantly below average intelligence (IQ <70-75) with impairment of at least two of the following skills: communication, self-care, use of community facilities, self-determination, health and personal safety. Treatment involves promotion, family counseling and social support. Mental retardation is regarded as a disease of the nervous system. Neurodevelopmental disorders are neurologically based conditions that occur early in childhood, usually affecting before starting school and the development of personal, social, academic and / or professional functioning. They usually include difficulty acquiring, in maintaining or application of specific skills or of rows of information. Disturbances in the development of the nervous system can result in dysfunction of attention, memory, perception, language, problem solving and social interaction. Other common neurologischemn developmental disorders attention deficit hyperactivity disorder, autism spectrum disorders and learning disorders include, for example, Dyslexia) Intellectual disability must age- functioning (ie, ability and socio-culturally appropriate standards for early childhood onset of deficits from both of the following include intellectual functions (eg. As reasoning, planning and problem solving, abstract thinking, learning in school or from experience) Adaptive to meet independent work in the activities of daily living) align the severity of the disease alone at IQ (mild mental retardation 52-70 or 75, even 36 to 51, heavy 20-35, extremely severe <20), is too vague. The classification must also provide the necessary tools in all activities - to much support from little - include. This type of therapy, the strengths and weaknesses of the person concerned at the center and puts them in relation to the requirements of the environment and the expectations of family and community. At approximately 3% of the total population of the IQ <70 is, two standard deviations below the average IQ of the general population (IQ <100). Considering only the need for aid, has only 1% of the population to severe mental retardation. A severe mental retardation occurs in all social strata and education levels. Less severe forms of mental retardation (occasional or limited support need) are often found in the lower social classes, parallel to the realization that the IQ rather correlated with school performance and social status than with specific physical factors. Nevertheless, recent studies suggest that even with the milder cognitive disorders, genetics may play a role. Etiology intelligence is determined by both the environment and genetics. Children of parents with mental retardation have an increased risk of developmental disorders, but a clear genetic inheritance for mental retardation does not exist. Although advances in genetics as chromosomal microarray analysis and the whole genome sequencing of the coding regions (exome) may be able to investigate more precisely the genetic causes of mental retardation, often can not identify any specific cause. One cause is found more in severe cases. Language problems and inferior social skills are usually more a problem of the state of mind of the isolation of the area, from learning disorders and deafness as a problem of mental retardation. Prenatal factors A number of chromosomal abnormalities and genetic metabolic and neurological disorders can cause mental retardation (see Table: Some chromosomal and genetic causes of mental retardation *). Among the congenital infections that cause mental retardation, including rubella, cytomegalovirus, Toxoplasma gondii, Treponema pallidum, herpes simplex virus and HIV. A prenatal Zika virus infection has been associated recently with congenital microcephaly and mental retardation. A prenatal drug and toxin exposure can cause mental retardation. Fetal alcohol syndrome is one of the most common causes. Anticonvulsants such as phenytoin or valproate, chemotherapy, radiation, lead and mercury are other causes. Even severe malnutrition during pregnancy may affect a child's brain development, which previa complications due to prematurity, cerebral hemorrhage, periventricular leukomalacia, forceps or bells birth, multiple birth, the placenta to mental retardation führt.Perinatale factors increase hypertensive disorders in pregnancy and perinatal oxygen deprivation the risk of mental retardation. The risk is increased for children with low birth weight. Decreased intelligence and low weight have a similar cause. Children with very or extremely low birth weight have, depending on the gestational age, perinatal events and the quality of care a different risk for mental Behinderung.Postnatale factors malnutrition and social deprivation (absence of physical, emotional and spiritual support, which are important for growth, development and social adaptation ) during the infant and toddler phase, the most common cause of mental retardation can be worldwide. Viral and bacterial encephalitis (including AIDS-associated neuro encephalopathy), meningitis (z. B. pneumococcal infections, Haemophilus influenzae infection, poisoning (lead, mercury), severe malnutrition and severe craniocerebral trauma or lack of oxygen can lead to mental retardation. Some chromosomal and genetic causes of mental retardation * cause example chromosomal abnormalities 5p deletion (Cri-du-chat syndrome) down's syndrome Fragile X syndrome Klinefelter syndrome mosaic trisomy 13 (Patau syndrome) trisomy 18 (Edwards syndrome) Turner syndromeGenetic metabolic diseases Autosomal recessive diseases aminoacidurias and -azidämien galactosemia maple syrup disease phenylketonuria lysosomal defects Gaucher disease Hurler's syndrome (mucopolysaccharidosis) Niemann-Pick disease Tay-Sachs disease Peroxisomenstörungen X-linked recessive diseases: Hunter syndrome (a variant of mucopolysaccharidosis) Lesch-Nyhan syndrome (hyperuricemia) Okulozerebrorenales syndrome (Lowe syndrome) Hereditary neurological disorders Autosomal dominant disorders: Myotonic Musk eldystrophie Neurofibromatosis Tuberous Sclerosis Autosomal recessive disorders: Primary microcephaly * This list is not exhaustive. Symptoms and complaints The primary symptoms are Slower acquiring new knowledge and skills immature behavior Limited autonomy Some children with mild retardation develop only in the school detectable symptoms. But children with moderate or severe intellectual disabilities or with additional physical disabilities or diseases (eg. As seizures) which have a specific cause (perinatal z. B. lack of oxygen) are identified early on. The delayed development can be seen as early as the preschool years. In older children, the main characters are a low IQ, combined with limited capabilities to adapt their own behavior. Although the development is a wide range, it is common for children with learning disabilities, to show rather slow progress as a standstill. The reason for psychiatric treatment and a aushäusige housing mentally handicapped children are mostly behavioral problems. Behavioral problems are situational in general; triggering factors can be often identified. Factors that may predispose to unacceptable behavior include lack of education for socially responsible practices Inconsistent discipline gain of misconduct Limited ability to communicate discomfort due to accompanying physical problems and mental illnesses such as depression or anxiety in homes (now in the US uncommon) wear problems overcrowding, lack of support staff and lack of activities both behavioral difficulties as well as to limited functional progress. The avoidance of a long-term accommodation with large care facilities is extremely important to maximize individual success. comorbid conditions Comorbid disorders are common, particularly attention deficit hyperactivity disorder, mood disorders (depression, bipolar disorder), autism spectrum disorders, anxiety disorders, and others. Some children suffer from cerebral seizures or gross motor development deficits, language delay or numbness. Such motor and sensory changes may feign mental retardation, but not its cause. Some children develop when they grow up, anxiety, or depression when they are socially rejected by others or find that they are rejected by others or considered stupid and different. Well-crafted education programs that integrate these children, promote social integration and maximum reduce such emotional reactions. Diagnosis Developmental Biology and intelligence assessment Imaging techniques for representing the CNS genetic testing in case of suspected mental retardation are studied mental development and intelligence. Standardized intelligence tests assess a below-average intelligence. but they are prone to errors and should be questioned if the results do not match the clinical findings. Diseases, disorders of the motor and sensory, language barriers or cultural differences can affect the test performance of the child. Such tests are based on the middle class, but in general they appreciate the intellectual abilities of children, especially older children, reasonable one. As a screening test for developmental disabilities, about the "Ages and Stages Questionnaire" (ASQ) or "the Parents' Evaluation of Development Status (PEDS) and can among other things be done by doctors .. These tests should be used as a screening test and not a substitute suitable . for detailed intelligence tests that should be conducted by psychologists the child should be examined neurodevelopmental as soon as a delay in development is a pediatric neurologist should investigate all cases of the type:. Moderate to severe developmental delays Progressive disability Neuromuscular deterioration Neonatal seizure syndromes If the diagnosis mental retardation is submitted shall be looking for a cause of an exact cause clarification helps to provide the prognosis for further development, education and training plans na. hezulegen perform genetic counseling and mitigate any feelings of guilt of the parents. Diagnosis of the causes for a detailed medical history (including perinatal development, neurological medical history and family history) can help uncover the cause. An investigation algorithm for children with intellectual disabilities was proposed by the Child Neurology Society. An MRI may be changes in the brain (as in the phacomatoses neurofibromatosis and tuberous sclerosis), show a treatable hydrocephalus or serious brain pathologies such as the Schizencephaly. Genetic testing can help to identify problems. Standard karyotyping is Down syndrome (trisomy 21) A chromosomal microarray identified copy number variants as they can be found or DiGeorge syndrome (chromosome 22q deletion) at 5P deletion (du chat syndrome cri) Direct DNA studies identify Fragile X syndrome chromosomal microarray analysis has become the preferred inspection tool; they can be used to specifically identify suspicious syndromes and if there is no specific syndrome is suspected. It has to identify otherwise undetected chromosomal abnormalities options, but requires parentage to interpret positive results. A complete genome sequencing of the coding regions (complete Exomsequenzierung) is a newer method that can reveal other causes of mental retardation. Clinical manifestations (eg., Growth difficulties, lethargy, vomiting, seizures, hypotonia, hepatosplenomegaly, dysmorphic features, abnormal urine odor, macroglossia) may be indicative of a genetic metabolic disorder. An insulated lagging behind in sitting or walking (gross motor skills) and the pincer grip, while painting and writing (fine motor skills) may be an expression of a neuromuscular disorder. Specific laboratory tests can clarify the underlying cause (see Table: Tests on some of the causes of mental retardation). Seeing and hearing should be examined at a young age and ruled lead poisoning. Tests on some of the causes of mental retardation Presumed cause Indexed tests Single large anomaly or more minor anomalies family history with cognitive disabilities chromosome analysis Chromosomal microarray analysis Cranial magnetic resonance imaging * May exome sequencing failure to thrive Idiopathic hypotension Genetic metabolic diseases HIV screening in high-risk infants nutritional and psychosocial Background to detection of amino acids in urine and blood and organic acid analysis and enzyme assay s Muscular to the exclusion of storage diseases or peroxisomal disorders enzymes SMA 12 (which contains albumin, alkaline phosphatase, AST, Total bilirubin, urea nitrogen, calcium, cholesterol, creatinine, glucose, P, total protein and uric acid) bone age, X-ray images of the skeletal system seizure EEG Cranial MRI * blood test for calcium, phosphorus, magnesium, amino acids, glucose and lead Cranial abnormalities (eg. As premature closure of sutures, microcephaly, macrocephaly craniostenosis, hydrocephalus) cerebral atrophy Cerebral malformations cerebral hemorrhage tumor Intracranial calcifications by toxoplasmosis, cytomegalovirus infection or tuberous sclerosis Cranial magnetic resonance imaging * TORCH screening urine culture for viruses chromosome analysis Chromosomal microarray analysis * After neurological consultation. SMA = sequential multiple analyzer; TORCH = toxoplasmosis, rubella, cytomegalovirus, herpes. Prognosis Many people with mild to moderate mental retardation can self support, live independently and can perform work with low intellectual demands. Life expectancy may be shortened depending on the cause of the disturbance. but the health care prolongs the lifetime of all concerned regardless of the origin of the developmental disorder. People with severe mental retardation need support for a lifetime. The more severe the disability, the greater immobility and therefore the risk of mortality. Treatment Early Intervention Program Multidisciplinary support team treatment and support are based on the cognitive abilities and social skills of the child concerned. A referral to a ECI center can prevent the severity of a mental disability, has a perinatal cause or reduce. A realistic care of the child in question must be sought. Support and advice of the family are important. will be confirmed as soon as a retardation or strongly suspected, this should be communicated to parents and giving them more time to discuss the causes, consequences, prognosis, education and training of the child. It is also important to oppose known prognostic risk the negative egocentric prophecies, in which low expectations bad effect on the later life. A sensitive further advice is important for the process of adaptation of the family. However, the practitioner should plan the medical attention and counseling. If the family doctor can not meet that, he should transfer the child and the family to a center with a multidisciplinary team that children studied with intellectual disabilities and treated. Appropriate specialists, including educators should develop a comprehensive, individualized program. Towards a multidisciplinary team includes neurologists or pediatricians who specialize in developmental disorders and behavioral disorders orthopedic surgeon neurologist or developmental pediatrician, orthopedic surgeons, physiotherapists and occupational therapists, who are responsible for dealing with the occurring motor disorders speech therapist and audiologist who help with language underdeveloped or suspected hearing loss nutritionists in the treatment of malnutrition employed social workers who help to improve the external conditions and to explore important resources are mentally handicapped children with concurrent psychiatric illnesses such as depression can be treated with antipsychotic medications in the same dosage as able-bodied. The use of antipsychotic drugs without a behavioral therapy or a change in the environment is rarely successful. It should be made to let the child live at home or in a community every effort. Although the life of a mentally handicapped child at home is sometimes very stressful, it can still be a very praiseworthy task. Besides helping with the daily care of day care centers, family helpers or care stations also provide psychological support to the family can be helpful. The living conditions should promote independence and strengthen all the skills needed to achieve this goal. Whenever possible, a child with an intellectual disability should attend a regular daycare or a normal public school. It is important that all children with disabilities receive appropriate educational opportunities and unhindered access to work and society. If mentally handicapped reach adulthood, they are suitable housing options and workplaces available. Large nursing homes are increasingly being replaced by small group homes or assisted living individually, matching the abilities of the person concerned in each case. Prevention Genetic counseling provides high-risk families background knowledge of the causes of disability. If a child has a mental disability, the family can be solved with a known cause of the risk in future pregnancies. Prenatal testing can be performed in high-risk couples who choose to have children. Prenatal diagnosis allows couples over an abortion and the subsequent family planning thinking. Tests include amniocentesis or chorionic villus sampling sonography Maternal serum alpha-fetoprotein amniocentesis or chorionic villus sampling can inherited metabolic disorders, chromosomal aberrations, carrier status and CNS defects (neural tube defects, anencephaly) discover. Amniocentesis can all women> 35 years, and all women are recommended with a family history of congenital metabolic diseases, as they have an increased risk of giving birth to a child with Down syndrome. Sonography is suitable for the detection of CNS defects. The determination of alpha-fetoprotein in the mother is a useful screening method for the detection of neural tube defects, Down syndrome or other disorders. Vaccines have eliminated almost congenital rubella and pneumococcal and H. influenzae meningitis as the cause of mental retardation. Continuous improvement, increasing availability of good prenatal care and newborn care, the possibility of exchange transfusion and anti-RH0 (D) immunoglobulin to prevent hemolytic disease of the newborn have reduced the incidence of mental retardation. Because of the growing incidence of surviving children with low birth weight, the prevalence has remained constant. Summary Mental retardation is a slow mental development with below average intellectual abilities, immature behavior and limited autonomy, so that a state is reached that requires supportive help. A number of prenatal, perinatal and postnatal disorders cause mental retardation, but in 60-80% of cases can be identified often no specific cause. Language problems and inferior social skills are usually more a problem of the state of mind of the isolation of the area, from learning disorders and deafness as a problem of mental retardation. Screenings with standardized tests such as the “GES and Stages Questionnaires” (ASQ) or “the Parents’ Evaluation of Development Status (PEDS) should be made. Conspicuous cases are then examined more closely on intelligence and neurological development. The search for specific causes done with cranial imaging, genetic testing (eg, chromosomal microarray analysis, Exom- sequencing.) and other tests as clinically indicated important is a comprehensive individualized program including support and advice to the family of a multidisciplinary team more information Practice parameters..: evaluation of the Child With Global Developmental delay

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