Developmental Disability Mental Retardation

Mental retardation is a substantial limitation in present functioning associated with subaverage intellectual capabilities and limitations in two or more adaptive skill areas (communication, self-care, home living, social skills, community use, self-direction, health and safety, functional academics, leisure, and work). It is a result of injury, disease, metabolic disorder, or other abnormality of the central nervous system occurring before the age of 18. Mental retardation occurs in 2.5 percent of the population. Etiology is known for certain syndromes associated with mental retardation, but the majority of individuals with mental retardation have no clearly identified etiology. Down syndrome, fetal alcohol syndrome, and fragile X syndrome are the most common known etiologies of mental retardation.

Dealing with the mentally retarded child in the ED is difficult because of the variety of medical problems that may be encountered and because the individual often is not able to clearly communicate the problem to the physician or the care provider. It is important to be aware that a child or care provider who cannot cooperate with questioning or physical examination may be mentally impaired.

Children with mental retardation have a wide variety of associated medical problems. With increasing severity of mental retardation, there is increased incidence of associated problems. Cerebral palsy, visual deficits, seizure disorders, failure to thrive, hypotonia, gastroesophageal reflux, aspiration, and psychiatric disorders have all been seen in the general population with mental retardation. Mental retardation associated with known syndromes may have diagnosis-specific medical problems such as in Down syndrome, the best known of these syndromes. Listings of diagnosis-specific medical problems can be found in Table 131-5..

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