Mental Retardation Follow-up

  • Author: Ari S Zeldin, MD, FAAP; Chief Editor: Amy Kao, MD   more...
 
Updated: Nov 10, 2010
 

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 coexisting motor impairments, the physician should monitor for secondary orthopedic disease. 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. Arthroplasty for progressive hip dislocation and/or tendon releases for progressive contractures due to spasticity may be required.
  • 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.
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Prognosis

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

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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.

Coauthor(s)

Alicia T F Bazzano, MD, MPH  Consulting Faculty, Division of Pediatric Emergency Medicine, Harbor/UCLA Medical Center; Attending Staff, Department of Emergency Medicine, Children's Hospital Los Angeles; Chief Physician, Westside Regional Center

Alicia T F Bazzano, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Public Health Association, and American Society for Bioethics and Humanities

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

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  Attending Neurologist, Children's National Medical Center, Washington DC

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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Table 1. Intellectual disability categorization
Category IQ



score*



(SD below mean)



Proportion of MR/ID Educational level/adaptive skills Intensity of supports required Prevalence in total population
Mild50-55 to 70



(2-3)



85%Up to about 6th grade; vocationalIntermittent, especially under stress0.9-2.7%
Moderate35-40 to 50-55



(3-4)



10%up to about 2nd grade; unskilled or semi-skilled, supervisedLimited;



usually supervised



0.3-0.4%
Severe20-25 to 35-40



(4-5)



4%May learn words; elementary self-care skillsExtensive; closely supervised group or family home
Profound< 20-25 (>5)1%Little to no self-care skillsConstant aid and supervision
*IQ scores are considered +/-5 points due to measurement error.
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