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Helping mentally retarded children and adolescents

March 29, 2006

Support from families and health care professionals have significant impact
The costs associated with mental retardation (MR) for persons born in 2000 will total over 51 billion dollars. While direct health and educational costs are significant, lifetime indirect costs due to productivity losses are much greater. Better efforts to understand the reasons for mental retardation and to develop effective strategies to both prevent and minimize the impact of MR will continue to be very important.

The April issue of Current Problems in Pediatric and Adolescent Health Care presents clinicians and other health care professionals with a concise treatment of all of the facets of mental retardation in children and young adults in a comprehensive review article entitled "Mental Retardation Diagnosis, Management, and Family Support" by Chris Plauché Johnson et al of the University of Texas Health Science Center, San Antonio. Beginning with a short description of theories of intelligence, the definition of mental retardation is reviewed and the epidemiology of the disorder is summarized. The article continues with a detailed outline of the etiology of mental retardation, practical information on making a correct diagnosis and various strategies for intervention. The article includes extensive references, lists of resources and useful tables.

Since chromosomal disorders are the most frequent known causes of mental retardation, the various tests that are now available are reviewed in detail. A summary of 8 recommendations for testing of children is presented, giving both physicians and families a plan for dealing with this disorder. The overview continues with extensive information about specific syndromes, not only including clinical presentation, complications and diagnostic tests, but also providing support information for parents who must care for a child with MR. Most of the article, in fact, deals with the various "quality of life" issues that affect the growth and development of a person with MR, including education, community integration, work and socialization, sexual maturation, and independent living.

The authors conclude that, "MR is one of the most common significant disabilities. Making a timely diagnosis of MR depends on a high index of suspicion, especially in a child who appears normal and demonstrates mild language delays. Diagnosis is a two-part process that includes the clinical diagnosis of MR based on DSM IV and/or AAMR criteria and a search for an etiology. Ideally it should also include a multidisciplinary approach in determining the level and kinds of supports that the individual will need over the life span. Management begins with prompt referral to an infant intervention program or, in older children, to a public education system. Children with MR should be cared for in the context of a medical home and receive ongoing quality health, dental and mental health surveillance, especially when the MR is associated with comorbid conditions. It is important to consider the well-being of all family members and help them identify and access appropriate public and community supports when necessary. Regardless of the degree of MR, parents should be encouraged to promote independence to the maximum extent possible throughout all stages of development. They should also begin long-term financial planning early in the child's life that will protect the child's entitlement to public supports as adults. The pediatrician plays important roles in recognition and diagnosis, promoting health and independence, preventing secondary disabilities, supporting both parents and siblings, and, finally, transitioning the adolescent to adult systems of care."

Elsevier Health Sciences