精神發(fā)育遲滯課件

1、精神發(fā)育遲滯精神發(fā)育遲滯 精神發(fā)育遲滯是指個體在發(fā)育階段（通常在18歲以前），由于先天的或后天的，生物學(xué)方面的或社會、心理方面的不利因素，使精神發(fā)育受阻或停滯，造成智力明顯低于平均水平及社會適應(yīng)困難。精神發(fā)育遲滯lMental retardation are manifested by behaviors that deviate from norms for the particular sociocultural group and age.Have subnormal intellectual functioning and commensurate deficits in adapti

2、ve functioning including capacities for social and personal sufficiency and independence.精神發(fā)育遲滯一般人群中，MR患病率1%3%WHO（1985）：輕度MR3%，重度34中國8省市014歲兒童（1988）：1.2%； 農(nóng)村城市，男女湖南416歲兒童（1990）：2.22%精神發(fā)育遲滯遺傳性異常：l常染色體隱性遺傳：如遺傳代謝性疾?。罕奖虬Y。l常染色體顯性遺傳：結(jié)節(jié)性硬化癥，神經(jīng)纖維瘤病等。l染色體畸變（結(jié)構(gòu)和數(shù)目的改變） 常染色體畸變：如Down Syndrome 性染色體畸變：Klinefelte

3、r綜合征,Turner綜合征l先天性顱腦畸形。精神發(fā)育遲滯精神發(fā)育遲滯精神發(fā)育遲滯 Estimated Cause Examples Frequency (%) Prenatal Genetic disorders 4.8 Chromosomal aberrations Down syndrome Single-gene mutations Tuberous sclerosis, phenylketonuria and other metabolic disorders, fragile X syndrome Multifactorial Familial mental retardation

4、 Malformation syndromes Prader-Willi, Williams, and Angelman due to microdeletions syndromes精神發(fā)育遲滯Congenital malformations 7.7 Malformations of the central Neural tube defects nervous system Multiple malformation Cornelia de Lange syndrome syndromes Estimated Cause Examples Frequency (%)精神發(fā)育遲滯 Estim

5、ated Cause Examples Frequency (%)Exposure 5.3 Maternal infectionsCongenital rubella, HIV Teratogens Fetal alcohol syndrome Toxemia, placentalPrematurity insufficiency Other Radiation, trauma精神發(fā)育遲滯 Estimated Cause Examples Frequency (%)Perinatal 2.0 Infections Meningitis Delivery problems Asphyxia Ot

6、her HyperbilirubinemiaPostnatal 3.2 Infections Encephalitis Toxins Lead poisoning Other postnatal causes Traumas, brain tumors Psychosocial problems Poverty, psychotic illnessUnknown 30.0精神發(fā)育遲滯 按IQ水平分：輕度：5069； 中度：3549； 重度：2034； 極重度：IQ20。精神發(fā)育遲滯精神發(fā)育遲滯精神發(fā)育遲滯l智力明顯低于同齡人的平均水平，在個別性智力測驗時智商（IQ）低于人群均值2.0標(biāo)準(zhǔn)差，在

7、70以下l社會適應(yīng)能力不足l起病于18歲以前精神發(fā)育遲滯lA.Significantly subaverage intellectual functioning: an IQ of approximately 70 or below on an individually administered IQ test (for infants, a clinical judgment of significantly subaverage intellectual functioning).lB.Concurrent deficits or impairments in present adapti

8、ve functioning (i.e., the persons effectiveness in meeting the standards expected for his or her age by his or her cultural group) in at least two of the following areas: communication, self-care, home living, social/interpersonal skills, use of community resources, self-direction, functional academ

9、ic skills, work, leisure, health and safety.lC.The onset is before age 18 years.lCode based on degree of severity reflecting level of intellectual impairment:l Mild mental retardation: IQ level 50.5 to approximately 70l Moderate retardation: IQ level 35.0 to 50.5l Severe mental retardation: IQ level

10、 20.5 to 35.0l Profound mental retardation: IQ level below 20 or 25l Mental retardation, severity unspecified: when there is a strong presumption of mental retardation but the persons intelligence is untestable by standard tests精神發(fā)育遲滯lFred was the product of an uncomplicated pregnancy and delivery.

11、Developmental milestones were remarkable for walking at 17 months of age, but slowness to talk and stammering, unclear speech. He was described as a little slow, but at 5 years of age when verbal and learning delays became more obvious, the family became concerned. At age 6, Fred was injured in an a

12、utomobile accident with resultant coma for 5 days. Hospital records at the time suggested the possibility of slight neurological injury, but his mother attributed all of Freds subsequent problems to this accident. He was unable to keep up in school and fell into greater conflict with his younger sib

13、lings. At 10 years of age he dropped out of school,精神發(fā)育遲滯land 4 years later was admitted to the Developmental Center. I.Q. testing over the years consistently placed Fred in the moderate range (middle to lower 50s). While in the institution Fred was seldom in trouble and worked on the wards, in the

14、kitchen, and occasionally as a messenger. After 3 years he was discharged to the community, where despite nearly continuous supervision from employers and social workers, he was said to be in frequent trouble. In virtually all of his multiple places of employment, primarily as a dishwasher, his repu

15、tation was highlighted by temper, aggression, profanity, and boorishness. He was also involved in several minor difficulties with police including several charges of vagrancy. On one occasion he took an employers car without permission and drove it recklessly. 精神發(fā)育遲滯lOver time, his conduct became mo

16、re competent, and at the age of 32 he presented as a robust-appearing man perpetually smoking a cigar who gave every appearance of being a happy-go-lucky, easygoing, altogether happy man. There is nothing in his appearance to suggest that he is anything less than a normal man, and his speech is like

17、wise unexceptionable?It is only upon much closer inspection that Freds intellectual deficit becomes apparent. To the casual observer, he is an ordinary man, competent to live within the not too demanding constraints of his life circumstances.精神發(fā)育遲滯lSpecify an I.Q. of 70 or less in their diagnostic c

18、riteria for mental retardation. lMeasurements of adaptive behavior, then, need to have a developmental orientation, to be socially and culturally sensitive, and to represent the many settings in which people live, work, and play.精神發(fā)育遲滯Measure Age Range Domains TestedVineland Adaptive Behavior Birth

19、to 18 Communication: receptive, expressive, Scales (Sparrow, Balla, and written; daily living skills: personal, Cicchetti, 1984) domestic; community socialization: interpersonal relations, play and leisure; coping skills; motor skills: fine, gross精神發(fā)育遲滯Scales of Independent Birth to 80+ Motor: fine,

20、 gross; social interaction and Behavior Revised (Bruininks, communication: social interaction, language Woodcock, Weatherman, & comprehension, language expression; Hill, 1996) personal living skills: eating and meal reparation, toileting, dressing; community, living skills: time and punctuality,

21、 money and value, work精神發(fā)育遲滯AAMR Adaptive Behavior Scales 3 to 18? Independent functioning, physical development, (Lambert, Nihira, and Leland, 1993) economic activity, schoolKaufman Functional Academic15 to 58+Functional math and reading skills, Skills (Kaufman and Kaufman, administered directly to person 1994)Street Survival Skills