《精神发育迟滞》

精神发育迟滞

（MentalRetardation,MR）整理课件定义精神发育迟滞是指个体在发育阶段（通常在18岁以前），由于先天的或后天的，生物学方面的或社会、心理方面的不利因素，使精神发育受阻或停滞，造成智力明显低于平均水平及社会适应困难。整理课件DefinitionsMentalretardationaremanifestedbybehaviorsthatdeviatefromnormsfortheparticularsocioculturalgroupandage.Havesubnormalintellectualfunctioningandcommensuratedeficitsinadaptivefunctioningincludingcapacitiesforsocialandpersonalsufficiencyandindependence.整理课件患病率一般人群中，MR患病率1%~3%WHO（1985）：轻度MR3%，重度3~4‰中国8省市0~14岁儿童（1988）：1.2%；农村＞城市，男＞女湖南4~16岁儿童（1990）：2.22%整理课件病因遗传性异常：常染色体隐性遗传：如遗传代谢性疾病：苯丙酮尿症。常染色体显性遗传：结节性硬化症，神经纤维瘤病等。染色体畸变（结构和数目的改变）常染色体畸变：如DownSyndrome性染色体畸变：Klinefelter综合征,Turner综合征先天性颅脑畸形。整理课件母孕期有害因素的影响：

感染：如风疹病毒等

药物与毒性物质

放射线照射

母体健康情况

母亲情绪因素

整理课件围产期不利因素：早产、难产、产伤、窒

息、颅内出血等

出生后不良因素：中枢神经系统感染、外

伤、缺氧、内分泌代谢疾病、婴幼儿期严重营养不良、缺乏文化教育机会整理课件

MentalRetardationCauses

EstimatedCause Examples Frequency(%)PrenatalGeneticdisorders 4.8Chromosomalaberrations DownsyndromeSingle-genemutations Tuberoussclerosis,phenylketonuriaand othermetabolicdisorders,fragileX syndromeMultifactorial "Familial"mentalretardationMalformationsyndromes Prader-Willi,Williams,andAngelmanduetomicrodeletions syndromes整理课件MentalRetardationCausesCongenitalmalformations 7.7Malformationsofthecentral NeuraltubedefectsnervoussystemMultiplemalformation CorneliadeLangesyndromesyndromes

EstimatedCause ExamplesFrequency(%)整理课件MentalRetardationCauses

EstimatedCause Examples Frequency(%)Exposure 5.3Maternalinfections Congenitalrubella,HIVTeratogens FetalalcoholsyndromeToxemia,placental PrematurityinsufficiencyOther Radiation,trauma整理课件MentalRetardationCauses

EstimatedCause Examples Frequency(%)Perinatal 2.0 Infections Meningitis Deliveryproblems Asphyxia Other HyperbilirubinemiaPostnatal 3.2 Infections Encephalitis Toxins Leadpoisoning Otherpostnatalcauses Traumas,braintumors Psychosocialproblems Poverty,psychoticillnessUnknown 30.0整理课件分级按IQ水平分：轻度：50~69；中度：35~49；重度：20~34；极重度：IQ＜20。整理课件轻度MR（75~80%）：IQ50~69。语言功能较好，

抽象思维、综合分析能力

较差；勉强小学毕业。日

常生活自理，可学会一技

之长。

中度（12%左右）：IQ35~49。语言发育较差词

汇贫乏，不能完整表达思；

数的概念模糊，不能计和

点数；学习能力低下。学

会简单的生活和工作技能，

常需要别人帮助。常有体

异常。

整理课件重度（7~8%）：IQ20~34。只能学会一些简单的

语言，有的不会说话；经过训练，

能学会自己吃饭及基本卫生习惯，

只能在监护下生活，不能进行生

产劳动。从小可发现躯体及神经

系统异常。

极重度（1~2%）：IQ20以下。无语言能力；对

周围环境及亲人不认识，仅

有原始情绪反应，以哭闹尖

叫表需求食物或不乐意；全

部生活需要人照料，出生时

即有明显的躯体畸形及神经

系统异常。

整理课件诊断标准智力明显低于同龄人的平均水平，在个别性智力测验时智商（IQ）低于人群均值2.0标准差，在70以下社会适应能力不足起病于18岁以前整理课件DSM-IVDiagnosticCriteriaA. Significantlysubaverageintellectualfunctioning:anIQofapproximately70orbelowonanindividuallyadministeredIQtest(forinfants,aclinicaljudgmentofsignificantlysubaverageintellectualfunctioning).B. Concurrentdeficitsorimpairmentsinpresentadaptivefunctioning(i.e.,theperson'seffectivenessinmeetingthestandardsexpectedforhisorheragebyhisorherculturalgroup)inatleasttwoofthefollowingareas:communication,self-care,homeliving,social/interpersonalskills,useofcommunityresources,self-direction,functionalacademicskills,work,leisure,healthandsafety.C. Theonsetisbeforeage18years.Codebasedondegreeofseverityreflectinglevelofintellectualimpairment:Mildmentalretardation:IQlevel50.5toapproximately70Moderateretardation:IQlevel35.0to50.5Severementalretardation:IQlevel20.5to35.0Profoundmentalretardation:IQlevelbelow20or25Mentalretardation,severityunspecified:whenthereisastrongpresumptionofmentalretardationbuttheperson'sintelligenceisuntestablebystandardtests整理课件CASEFredwastheproductofanuncomplicatedpregnancyanddelivery.Developmentalmilestoneswereremarkableforwalkingat17monthsofage,butslownesstotalkandstammering,unclearspeech.Hewasdescribedasalittleslow,butat5yearsofagewhenverbalandlearningdelaysbecamemoreobvious,thefamilybecameconcerned.Atage6,Fredwasinjuredinanautomobileaccidentwithresultantcomafor5days.Hospitalrecordsatthetimesuggestedthepossibilityofslightneurologicalinjury,buthismotherattributedallofFred'ssubsequentproblemstothisaccident.Hewasunabletokeepupinschoolandfellintogreaterconflictwithhisyoungersiblings.At10yearsofagehedropped

outofschool,整理课件CASEand4yearslaterwasadmittedtotheDevelopmentalCenter.I.Q.testingovertheyearsconsistentlyplacedFredinthemoderaterange(middletolower50s).WhileintheinstitutionFredwasseldomintroubleandworkedonthewards,inthekitchen,andoccasionallyasamessenger.After3yearshewasdischargedtothecommunity,wheredespitenearlycontinuoussupervisionfromemployersandsocialworkers,hewassaidtobeinfrequenttrouble.Invirtuallyallofhismultipleplacesofemployment,primarilyasadishwasher,hisreputationwashighlightedbytemper,aggression,profanity,andboorishness.Hewasalsoinvolvedinseveralminordifficultieswithpoliceincludingseveralchargesofvagrancy.Ononeoccasionhetookanemployer'scarwithoutpermissionanddroveitrecklessly.整理课件CASEOvertime,hisconductbecamemorecompetent,andattheageof32hepresentedasarobust-appearingmanperpetuallysmokingacigarwhogaveeveryappearanceof"beingahappy-go-lucky,easygoing,altogetherhappyman.Thereisnothinginhisappearancetosuggestthatheisanythinglessthananormalman,andhisspeechislikewiseunexceptionable?ItisonlyuponmuchcloserinspectionthatFred'sintellectualdeficitbecomesapparent.Tothecasualobserver,heisanordinaryman,competenttolivewithinthenottoodemandingconstraintsofhislifecircumstances."整理课件CognitiveandAdaptiveFunctioningSpecifyanI.Q.of70orlessintheirdiagnosticcriteriaformentalretardation.Measurementsofadaptivebehavior,then,needtohaveadevelopmentalorientation,tobesociallyandculturallysensitive,andtorepresentthemanysettingsinwhichpeoplelive,work,andplay.整理课件

CommonMeasuresofAdaptiveBehaviorMeasure AgeRange DomainsTestedVinelandAdaptiveBehaviorBirthto18 Communication:receptive,expressive,Scales(Sparrow,Balla,and written;dailylivingskills:personal,Cicchetti,1984) domestic;communitysocialization: interpersonalrelations,playandleisure; copingskills;motorskills:fine,gross整理课件CommonMeasuresofAdaptiveBehaviorScalesofIndependentBirthto80+Motor:fine,gross;socialinteractionandBehaviorRevised(Bruininks, communication:socialinteraction,languageWoodcock,Weatherman,& comprehension,languageexpression;Hill,1996) personallivingskills:eatingandmeal reparation,toileting,dressing;community, livingskills:timeandpunctuality,money andvalue,work整理课件CommonMeasuresofAdaptiveBehaviorAAMRAdaptiveBehaviorScales3to18?Independentfunctioning,physicaldevelopment,(Lambert,Nihira,andLeland,1993) economicactivity,schoolKaufmanFunc