Diagnosis of mental retardation

Issues related to the diagnosis and assessment of the degree of intellectual disability are resolved by psychiatrists based on all available data from clinical, pathopsychological and paraclinical studies. The pediatrician's task is to pay attention to deviations in the child's mental development as early as possible and refer him for consultation with specialists. Warning signs of mental retardation in children under one year:

• features of the structure of the head, face and body;
• congenital malformations:
• a peculiar mousey smell emanating from the urine and body of a child with phenylketonuria;
• severe muscular hypotonia in a newborn with Prader-Willi syndrome.

An indication for a psychiatrist consultation is a clear discrepancy between the level of mental development and the passport age of the child. In the presence of developmental defects and minor congenital anomalies, an additional consultation with a geneticist is necessary.

Diagnostic criteria and assessment scales for mental retardation

Although mental disorders accompanying mental retardation are often difficult to characterize, effective treatment is impossible without their clear identification. Rating scales that involve assessing the patient's behavior based on observation are recommended for assessing the effectiveness of drug treatment. For example, the Aberrant Behavior Checklist-Community Version (ABC-CV) can be used to assess the effectiveness of a drug. The scale allows one to quantitatively assess the severity of the main, "status" symptoms based on information received from the patient's observers. The Connors scale is used to assess hyperactivity and attention deficit disorders. For example, this scale was used to assess the effectiveness of methylphenidate in attention deficit hyperactivity disorder in patients with mental retardation. Particularly difficult is the assessment of affective disorders such as anxiety or depression in patients with mental retardation. For this purpose, special methods are used, for example, the Psychopathology Inventory for Mentally Retarded Adults (PIMRA), the Reiss Screen for Maladaptive Strongehavior, and the Emotional Disorders Rating Scale-DD.

When planning treatment for patients with mental retardation, it is of great importance to identify and correct concomitant mental disorders - major depression, bipolar disorder, anxiety disorders, general disorder.

Diagnostic criteria for mental retardation

• A. Significant decline in intellectual functions: when performing intelligence tests, the IQ value does not exceed 70 (in young children - clinically obvious decline in intellectual functions)
• B. A combination of deficits or impairments in adaptation (i.e., the person's behavior does not correspond to age-appropriate norms in a given cultural group) in at least two of the following areas: communication, self-care, functioning in the home, social/interpersonal skills, use of community resources, autonomous goal-directed behavior, functional academic skills, work, leisure, health, safety
• B. Onset before age 18

The code depends on the severity, reflecting the level of intellectual impairment:

• Mild mental retardation - IQ from 50-55 to approximately 70
• Moderate mental retardation - IQ from 35-40 to 50-55
• Severe mental retardation - IQ from 20-25 to 30-35
• Severe mental retardation - IQ below 20-25

Mental retardation without specifying severity: when there are sufficient grounds for diagnosing mental retardation, but in the absence of data from standard intelligence tests (for example, when it is impossible to conduct them due to the severity of the condition, the patient's unwillingness, or infancy)

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