Mental retardation: stages (degrees), symptoms and other information

The essence of the problem

Mental retardation is a serious limitation in the skills necessary for daily life, social and intellectual activities. Such individuals experience problems with speech, motor development, intelligence, adaptation, emotional-volitional sphere, and cannot interact normally with the environment.

This definition was given by AAIDD - the American Association for Developmental and Intellectual Disabilities, which changed its approach to this problem. It is now believed that providing ongoing, personalized support can improve the quality of life of a mentally retarded person. Yes, the term itself was replaced with a more tolerant and inoffensive one – “intellectual disability”.

In addition, such a disease is now not considered mental. And it should not be confused with developmental disabilities. The latter covers a broader area, but is very closely related to the first: autistic disorders, cerebral palsy, etc.

Oligophrenia is a chronic non-progressive disease that occurs as a result of brain pathology in the prenatal period or after birth (up to three years).

Despite the achievements of modern medicine and serious preventive measures, it cannot give an absolute guarantee that this disease will not appear. Currently, 1 to 3% of people worldwide suffer from UO, but most suffer from a mild form (75%).

There is also acquired mental retardation - dementia. This is a separate “age-related” pathology in older people, a consequence of natural brain damage and, as a result, the collapse of mental functions.

How to make an appointment with a neurologist

Mental retardation requires an integrated approach, so you need to make an appointment with not just one specialist, but several. Initially, it is recommended to see a neurologist, who, after an examination, will determine which doctors the patient still needs. JSC "Medicine" (clinic of academician Roitberg) is located in the center of Moscow near the Mayakovskaya, Novoslobodskaya, Chekhovskaya, Belorusskaya metro stations. You can make an appointment with a neurologist, speech therapist, child psychiatrist and other doctors by phone. Also use the feedback form by sending a request, or request a call back.

Causes

Intellectual disability is the result of genetic diseases and many other factors, or rather, their combination: behavioral, biomedical, social, educational.

No one can accurately name the specific “culprits,” even despite fairly scrupulous research and early diagnosis. But, if you analyze the table, the most likely cause of oligophrenia may be:

• any genetic failures - gene mutations, their dysfunction, chromosomal abnormalities;
• hereditary developmental disorders;
• malnutrition;
• infectious diseases of the mother during pregnancy - syphilis, rubella, HIV, herpes, toxoplasmosis, etc.;
• premature birth;
• problematic childbirth - asphyxia, mechanical injuries, hypoxia, fetal asphyxia;
• insufficient upbringing of the child from birth, parents devoted little time to him;
• toxic effects on the fetus leading to brain damage - parental use of strong drugs, drugs, alcoholic beverages, smoking. This also includes radiation;
• infectious diseases of the child;
• skull injury;
• diseases affecting the brain - encephalitis, whooping cough, meningitis, chicken pox;
• drowning.

Preventive measures

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Prevention measures are a set of simple rules and recommendations:

• identify diseases in expectant mothers that provoke the development of defects in the fetus: rubella, measles, sexually transmitted diseases;
• good obstetric care is required to prevent birth injuries, fetal hypoxia, and infection;
• a healthy lifestyle for a pregnant woman, excluding smoking, drinking, taking drugs and medications that can harm the baby;
• measures aimed at preventing women from contracting infectious diseases.

Degrees of mental retardation

Intellectual disability is divided into 4 stages. This classification is based on special tests and is based on the IQ level of intelligence:

• mild (moronicity) – IQ from 70 to 50. Such an individual has impairments in abstract thinking and its flexibility, short-term memory. But he speaks normally, albeit slowly, and understands what is said to him. Often such a person cannot be distinguished from others. But he is not able to use the acquired academic skills, for example, financial management, etc. In social interactions, he lags behind his peers, so he may fall under the negative influence of others. He can perform everyday simple tasks himself, but more complex ones require outside help;
• moderate (not very pronounced imbecility) – IQ 49–35. A person needs constant continuous patronage, including for establishing interpersonal relationships. Spoken speech is very simple, and he does not always correctly interpret what he hears;
• severe (severe imbecility) – IQ from 34 to 20. A person does not understand speech well, numbers, the concept of time is not available to him - for him everything happens here and now. Speaks in monosyllables, vocabulary is limited. Needs constant monitoring and care in terms of hygiene, clothing, nutrition;
• deep (idiocy) – IQ level less than 20. Speech, its understanding and sign language are very limited, but are able to express simple words and instructions, as well as their desires and emotions using non-verbal communication. Severe sensory and motor problems are present. Completely dependent on others.

It should be noted that with long-term and persistent training of people with any degree of dementia, they can achieve basic skills.

Classification

Based on the results of intelligence tests using the Wechsler method, better known as determining IQ (normally, this indicator should be above 80, IQ between 70–80 is considered a borderline form of developmental delay), 3 stages of oligophrenia are distinguished:

• mild (moronic), IQ 50–70;
• moderate (imbecility stage), IQ 35–49;
• severe and deep (pronounced imbecility and idiocy), IQ less than 34.

Diagnostic criteria

According to DSM-5 (the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders), intellectual disability is a neurodevelopmental disorder, characterized and defined by the following symptoms:

1. Deficits in intellectual functioning. Difficulties with abstract thinking, reasoning, decision making, and learning. All this must be confirmed by appropriate tests.
2. Deficit of adaptive behavior. Inconsistency with accepted cultural and social standards, inability to live independently, reduced social responsibility, difficulties with communication. That is, the individual cannot communicate and serve himself and needs care wherever he is.
3. A person finds it difficult to perform tasks that require memory, attention, speech, writing, reading, mathematical reasoning, and is unable to gain practical skills.
4. Problems in the social sphere. Does not have socialization skills - communication with people, cannot make friends and maintain relationships. Doesn't understand his feelings and thoughts.
5. Problems in the practical field. Poor ability to learn skills, lack of control over one’s own behavior, inability to take care of oneself, irresponsibility, etc.

Other signs

Together with the mentioned criteria, the presence of any stage of CP can be determined by the following criteria.

In the primary period of development, a healthy child masters simple skills, which, as they grow older, are well mastered and move on to more complex ones. Adaptive and intellectual problems become noticeable as the child develops. When they appear depends on the type, cause and degree of mental retardation.

The stages of development (motor skills, speech, socialization) of children with intellectual disabilities are the same as those of healthy people, but they progress much more slowly, that is, they reach a certain level much later. With a mild form of mental retardation, the lag behind peers becomes noticeable only at the beginning of school (learning difficulties), and with a severe form - in the first years of life.

As a rule, if intellectual disability is inherited (by genes), it affects the person’s appearance.

Oligophrenics are more likely to have physical, neurological and other health problems. For such individuals, sleep disturbances, anxiety disorders, and schizophrenia are also common. Diabetes, obesity, sexually transmitted diseases, and epilepsy are common.

People with mild to moderate intellectual disabilities speak much less well than their younger peers. The higher the level of disorder, the worse the speech.

Behavioral disorders characteristic of oligophrenics are associated with the discomfort they experience when communicating, the inability to communicate their thoughts to others, and a misunderstanding of their desires and needs. In addition, they suffer from social isolation. This is where manifestations of excitement, anxiety, nervousness, etc. follow.

Complications

Oligophrenia can be complicated by other mental and somatic disorders.

Mental disorders include behavioral disorders - a tendency to impulsive actions, aggressive behavior with socially dangerous actions, incl. with self-harm. Violation of social and labor adaptation due to intellectual retardation expressed to varying degrees. These behavioral disorders are difficult to correct.

The risk of developing somatic complications depends on the quality of patient care. With poor care, bedsores, skin infections, sometimes pneumonia, etc. can occur.

Syndromes combined with different degrees of MR

Down syndrome is the most common genetic cause of intellectual disability. It is caused by a chromosomal abnormality - if normally there are 46 of them, then in this case there is an unpaired 47th chromosome. People with this syndrome can be identified by an abnormally short skull, flat face, short arms and legs, short stature, and small mouth. They process the information received poorly and remember it, they lack the concept of time and space, and their speech is poor. Moreover, such individuals adapt well to society.

Martin-Bell syndrome (fragile X chromosome). The second most common genetic cause of mental retardation. It is recognized by the following external features: increased mobility of joints, an elongated face, an enlarged chin, a high forehead, large, protruding ears. They start talking late, but poorly, or don’t speak at all. They are very shy, hyperactive, inattentive, constantly moving their hands and biting them. Men have more cognitive impairment in this category than women.

Williams syndrome (“elf face”). It occurs as a result of hereditary chromosomal rearrangement, the loss of genes in one of them. The patients have a very interesting appearance: the face is narrow and long, blue eyes, flat nose, large lips. Usually suffer from cardiovascular diseases. Rich vocabulary, good memory, excellent musical abilities, and social interaction skills. But there are problems with psychomotor skills.

Angelman syndrome (happy doll or Parsley). Caused by a change in chromosome 15. Very light eyes with characteristic spots on the iris and hair, the head is small, the chin is pushed forward, the mouth is large, the teeth are sparse and long. Severe delay in psychomotor development, significant impairment of speech and movement (poor balance, walks on stiff legs). He often smiles and even laughs for no reason.

Prader-Willi syndrome . It is characterized by the absence of a paternal copy of chromosome 15 and a number of other disorders. He is short in stature, has small arms and legs, suffers from compulsive overeating, and, as a result, obesity. Problems with short-term memory, speech, information processing.

Lejeune's syndrome (cry of the cat or 5p syndrome). A very rare and serious disease caused by the absence of the short arm of chromosome 5. The head is small, the face is round, the lower jaw is underdeveloped and the bridge of the nose is wide, so the eyes are located far from each other. The feet are turned out, the hands are small. The larynx is underdeveloped, there are vision problems, in particular, strabismus. She often cries and makes a sound similar to a kitten meowing. Motor development is delayed, and the ability to pay attention is limited.

In addition to the syndromes mentioned, intellectual disability can coexist with cerebral palsy, deafness and blindness, autistic disorders, epilepsy and other somatic and mental illnesses.

Children with intellectual disabilities

Society must be tolerant of people with mental retardation; a special approach and teachers are needed who know the specifics of the work, who can give intellectual disabilities an education and help them realize their potential.

Children with disabilities need the support of others, especially parents, who must provide such children with psychological comfort, development, and improve their quality of life.

In infants, it is quite difficult to identify mental retardation, especially its mild form, since they are almost no different from others. But their activity is impaired: they begin to hold their heads up late, babble, sit, and crawl.

But as the child grows up, when he begins to go to kindergarten, it becomes noticeable that he has difficulty maintaining a daily routine, communicating with peers, and mastering new skills. For example, a three-year-old child cannot assemble a pyramid on his own, although he repeated this many times with the teacher. My classmates succeeded after 1-2 lessons.

Oligophrenic children are not inquisitive; they cannot sit in one place for a long time, but they get tired very quickly. Their speech is poor, they confuse letters (especially consonants). Since their phonemic hearing and analysis are poorly developed, they pronounce words incorrectly, and then write incorrectly. The development of auditory discrimination and the articulatory speech apparatus lags behind - hence slurred speech.

Gross and fine motor skills suffer as the central nervous system develops abnormally. The baby's movements are uncertain and sluggish, he manipulates objects chaotically. For a long time he cannot determine the “main” hand; he moves both of them inconsistently.

Difficulties with the “pinch” and “tweezer” grip do not allow the child to hold a pencil and pen correctly and learn to write. Underdevelopment of fine motor skills also makes it difficult to care for oneself.

The child cannot concentrate and remember something. This negatively affects cognitive activity and mental activity. The baby does not see or hear what is said to him due to attention problems.

Studying is difficult for such children: they learn the material slowly because they do not remember it and cannot reproduce the information received. They cannot apply the skill or knowledge they have learned after repeated repetitions and quickly forget it.

The child is not able to express feelings verbally, because he has poor speech, but he expresses emotions through facial expressions, touches, and gestures. He is incapable of empathy. His will is weak, so he is trusting of any person, easily suggestible, and this is very dangerous.

Contact a specialist (neurologist) without delay if your child behaves unusually or you do not understand what is happening to him. The benefit of this is double - in the best case, all doubts about the adequacy of your child will be dispelled, and in the worst case (which, however, is also not bad) - early diagnosis will allow you to immediately take measures to solve the problem. This will allow such a child to be better socialized and adapted to life.

The doctor will examine the little patient, ask the parents about the symptoms, when they appeared, about the child’s practical and social skills, adaptive behavior, etc. An intelligence test is required to find out how teachable the child is, how he can solve problems and think abstractly. An IQ below 70 may indicate the presence of intellectual disability and its level.

Tips for parents

The following recommendations can be given to mothers and fathers of special children:

1. Of course, hearing such a diagnosis for your child is a terrible blow, causing negative thoughts. There is a feeling of guilt, resentment at fate, anger, despair, melancholy. But you still have to accept this fact, come to terms with it, and communication with other parents who have a similar problem can be a good support. It’s also a good idea to visit a psychologist.
2. You need to clearly separate your capabilities from what is impossible to do and, without giving up, look for ways to solve problems and means.
3. Consult with specialists. It is also advisable to collect as much information as possible from serious sources about mental retardation, how and how you can help the child, what exactly should be done, where to go. The experience of families with an oligophrenic child is invaluable, communicate with them.
4. Learn about and take advantage of government and community services for families with children with mental retardation.
5. Think not about limitations, but about your child’s capabilities, what he can do and what he needs, how to please him. It is in your power to help him become independent and socialize as much as possible.
6. Under no circumstances isolate your child from other people, neither children nor adults.
7. Despite the fact that the level of development of your child at certain stages is lower than that of his peers, you need to communicate with him not as with a baby, but in accordance with his age.
8. It is necessary to regularly conduct developmental and training sessions. The goal of education is social adaptation, that is, the child must master speech, writing, and everyday independence.

Don’t expect anything special from all your efforts, some super-result, be happy with the smallest progress. But we shouldn’t stop there either. Even if you understand your child by individual words, this is not enough for communication with others and social adaptation. Move on, don't give up and don't indulge your child's laziness.

To reduce the likelihood of having a mentally retarded child, a pregnant woman should:

• DO NOT drink, smoke or take drugs;
• take folic acid;
• visit a doctor regularly;
• Eat a diet containing fruits and vegetables, whole grains, and foods low in saturated fat.

After the baby is born:

• carry out screening of the baby - this will identify diseases that can provoke mental retardation;
• visit your pediatrician regularly;
• do all scheduled vaccinations;
• allow him to ride a bicycle only with a helmet, and to ride in a car until the required age only in a car seat;
• Avoid contact of your child with household chemicals and lead-based paints.

Support by specialists

A child with an intellectual disability needs comprehensive support throughout childhood from the following specialists:

• child psychologist and psychiatrist;
• speech therapist;
• neurologist;
• speech pathologist.

If there are other disorders (blindness, deafness, cerebral palsy, autism spectrum disorder), then a rehabilitation specialist, an ophthalmologist, a massage therapist, and a physical therapy teacher are added to the above-mentioned professionals.

Treatment in Re-Alt

In most cases of oligophrenia, the disorder cannot be completely cured. Correction of the condition is possible with enzymopathies if treatment is started in a timely manner.

Therapy of other forms is only symptomatic. Treatment of oligophrenia in a hospital is indicated for severe behavioral disorders, acute psychotic symptoms, and mood disorders. Sometimes, hospitalization is necessary for differential diagnosis with other disorders.

Light and moderate forms are corrected. Psychological and pedagogical correction tactics are developed based on the severity of the disorder. Depending on the condition of the patients, if possible, the necessary household and work skills are taught, speech and thinking are developed, and adaptation to environmental conditions is carried out. Drug treatment of adult patients does not improve intelligence. People with severe forms must be accompanied and supervised at all times. Specialists at the Re-Alt mental health center train relatives caring for the patient on proper care and helping patients adapt.

If the cause of oligophrenia is identified, treatment is carried out in accordance with it and the clinical picture. In the presence of severe psychotic symptoms and behavioral disorders, pharmacotherapy is prescribed (nootropics, multivitamins, neurometabolics, antioxidants, biogenic stimulants, antihypoxants). Children with concomitant mental disorders are prescribed appropriate psychotropic medications. Pharmacotherapy is carried out in combination with behavioral therapy and adaptation to the environment.

It is advisable for a child with this disorder to live in a family or in a boarding school with shared accommodation, if there is no problem with providing control and support. Living surrounded by close people has the most beneficial effect on his condition. The child's environment should encourage independence and reinforce acquired skills.

Is oligophrenia curable?

Treatment and correction of this disease is not an easy task; it will require a lot of effort, time, and patience. In addition, different levels of mental retardation and the age of the patient require their own methodology. However, if the tactics are chosen correctly, a positive result becomes noticeable within a couple of months.

Unfortunately, complete relief from intellectual disability is impossible. The thing is that certain parts of the brain are damaged. The nervous system to which it belongs is formed during the period of intrauterine development of the fetus. After the birth of a child, its cells almost do not divide and are not able to regenerate. That is, the damaged neurons will not recover and mental retardation remains with the person for the rest of his life, although without progressing.

But, as already mentioned, children with a mild degree of the disease respond well to correction, receive self-care skills, education, and can work quite normally, performing simple tasks.

Diagnostics

To identify signs of oligophrenia, the following are carried out:

• Analysis of patient complaints. Study of anamnesis. It turns out: - at what age did symptoms of mental development begin to appear; — how the mother’s pregnancy proceeded; - How often did the patient catch colds in childhood? - what diseases did you suffer before the age of three? - how you ate (whether you were hungry).
• An examination by a psychiatrist, during which the patient’s intellectual abilities are assessed using special scales, questionnaires, during a normal conversation. At the same time, the doctor studies how developed the speech of the oligophrenic is, whether he can adapt to new conditions, how he communicates with relatives and friends.
• MRI, CT scan of the head, which make it possible to study the structure of the brain layer by layer and detect its damage (if any).

Support for people with disabilities

This disease develops in different ways, but it is very important to diagnose it as early as possible. In this case, specialists will begin to work closely with such a patient at an early age, which significantly improves his condition and quality of life.

Such assistance is necessarily personalized, that is, it is planned taking into account the individual characteristics of the patient, his needs and desires. People with this diagnosis are not the same, therefore, help for each of these individuals in the sphere of life and certain activities should have its own type and intensity.

In many countries of the world, including ours, special programs have been developed whose goal is to improve the quality of life of people with mental retardation. They are integrated, “dissolved” in society. Children with mild degrees of the disease go to auxiliary schools and kindergartens, inclusive classes in regular educational institutions. There are even groups in vocational schools where you can get an education and then work in your specialty.

Correction and assistance

Treatment is mainly symptomatic:

• psychotropic and nootropic drugs;
• general strengthening;
• anticonvulsants and dehydration;
• metabolic.

Easily tired and lethargic patients are prescribed drugs that stimulate the psyche, which make them more active and active. Particularly excitable people are prescribed neuroleptics and antipsychotics, slightly extinguishing and “slowing down” their mental reactions.

Speech therapists, psychologists, and teachers work with patients. In childhood, such treatment is especially necessary. It helps to better assimilate knowledge, acquire skills, develop independence, teach one to navigate the world and socialize.

The main task of medicine is aimed at helping the patient adapt to society, learn to live independently, and master simple specialties. Rehabilitation and social adaptation centers teach life in society.

The success of adaptation depends on properly organized conditions of study, work, and well-established everyday life. There is no need to demand the impossible from children: they should study in specialized schools that correspond to their level of development, work in areas where attention, initiative, and creativity are not required. Correct adaptation can give the patient everything: work, family, friends and a decent standard of living.