eMedicine Specialties > Neurology > Pediatric Neurology

Mental Retardation: Follow-up

Author: Ari S Zeldin, MD, FAAP, Senior Clinical Fellow/Clinical Instructor in Autism and Neuro-Developmental Disorders, Division of Pediatric Neurology, Department of Neurosciences, University of California, San Diego, School of Medicine
Contributor Information and Disclosures

Updated: Jan 11, 2010

Follow-up

Further Outpatient Care

  • Individuals with MR should be evaluated at least annually by a neurologist or neurodevelopmental pediatrician with a special interest in the etiology and management of cognitive disorders. The physician should have adequate knowledge of the educational, social, and support services available in the community; assessing the appropriateness of the patient's individualized habilitation is important.
  • To maximize the individual's functional independence, the following areas should be addressed by the physician at least annually:
    • Treatment of associated impairments
    • Pharmacotherapy
    • Behavior management
    • Educational services
    • Recreational needs
    • Family counseling
  • The annual visit requires routine preventive medicine and coordination of specialized services such as dental and gynecologic care under sedation. Supplemental vaccines, including the influenza and hepatitis B vaccines, are particularly prudent for those in residential placements. A careful behavioral history is important to identify newly emerging maladaptive behaviors that may be treated effectively with behavior management.
  • If patients have co-existing motor impairments, the physician should monitor for secondary orthopedic disease. Arthroplasty for progressive hip dislocation and/or tendon releases for progressive contractures due to spasticity may be required. Advanced knowledge in the pharmacologic management of spasticity and rigidity allows the clinician to refer the patient for botulinum toxin injections or baclofen pump insertion when appropriate.
  • The health maintenance schedule for individuals with Down syndrome is well recognized. Ongoing audiologic monitoring, thyroid function tests, and screening for atlantoaxial instability are important components.

Prognosis

  • Individuals with MR fare better today than at any other recorded time in world history.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Individuals in the United States older than 18 years are no longer under the guardianship of their biological parents. No exceptions are made for children with MR. The majority of these individuals, particularly those in the range of mild MR, are capable of making appropriate legal decisions when adequately and appropriately informed of the decision outcomes.
  • Some individuals may not be capable of comprehending the long-term implications of the medical or legal matter at hand. In such cases, the decision is best made by a member of the biological family; the family member must obtain guardianship status for power of attorney over these matters. If a family member is unavailable to serve as guardian, then a guardian ad litum can be assigned by the court for assistance in such legal and medical matters.
  • Complex decisions, particularly those involving issues of sterilization, are perhaps best handled by committee with the assistance of the ethics committee of the involved medical institution.
  • Failure to identify a genetic cause of MR with risks to other family members or risks to the patient for future medical complications are potential medical/legal pitfalls.
  • Perhaps 1 in 8 convicts on death row in the United States has mental retardation. Many persons cannot fully comprehend the Miranda Rights and other critical concepts necessary to maneuver through the criminal justice system.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Karen H Harum, MD to the development and writing of this article.



More on Mental Retardation

Overview: Mental Retardation
Differential Diagnoses & Workup: Mental Retardation
Treatment & Medication: Mental Retardation
Follow-up: Mental Retardation
References
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Further Reading

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Keywords

cognitive impairment, intelligence quotient, IQ less than 70, learning disability, Down syndrome, Fragile X syndrome, Prader-Willi syndrome, Angelman syndrome, Smith-Magenis syndrome, CATCH 22 (22q11 deletion) syndrome, DiGeorge syndrome, velocardiofacial syndrome, Williams syndrome, Wolf-Hirschhorn syndrome, Langer-Giedion syndrome, Miller-Dieker syndrome, tuberous sclerosis, Rubinstein-Taybi syndrome, Coffin-Lowry syndrome, Rett syndrome, Smith-Lemli-Opitz syndrome, fetal alcohol syndrome, fetal alcohol effects, cretinism, congenital hypothyroidism, congenital cytomegalovirus, congenital rubella, intraventricular hemorrhage, hypoxic-ischemic encephalopathy, traumatic brain injury, shaken baby syndrome, meningitis

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Contributor Information and Disclosures

Author

Ari S Zeldin, MD, FAAP, Senior Clinical Fellow/Clinical Instructor in Autism and Neuro-Developmental Disorders, Division of Pediatric Neurology, Department of Neurosciences, University of California, San Diego, School of Medicine
Ari S Zeldin, MD, FAAP is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, and Child Neurology Society
Disclosure: Nothing to disclose.

Medical Editor

Beth A Pletcher, MD, Associate Professor, Co-Director of The Neurofibromatosis Center of New Jersey, Department of Pediatrics, University of Medicine and Dentistry of New Jersey
Beth A Pletcher, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Medical Genetics, American Medical Association, and American Society of Human Genetics
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Kenneth J Mack, MD, PhD, Senior Associate Consultant, Department of Child and Adolescent Neurology, Mayo Clinic
Kenneth J Mack, MD, PhD is a member of the following medical societies: American Academy of Neurology, Child Neurology Society, Phi Beta Kappa, and Society for Neuroscience
Disclosure: Nothing to disclose.

Chief Editor

Amy Kao, MD, Assistant Professor, Department of Pediatrics, Division of Pediatric Neurology, Department of Neurology, Oregon Health and Science University; Consulting Staff, Shriners Hospital for Children
Amy Kao, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, American Epilepsy Society, and Child Neurology Society
Disclosure: Nothing to disclose.

 
 
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