《精神發(fā)育遲滯》

精神發(fā)育遲滯

（MentalRetardation,MR）整理課件定義精神發(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困難。整理課件DefinitionsMentalretardationaremanifestedbybehaviorsthatdeviatefromnormsfortheparticularsocioculturalgroupandage.Havesubnormalintellectualfunctioningandcommensuratedeficitsinadaptivefunctioningincludingcapacitiesforsocialandpersonalsufficiencyandindependence.整理課件患病率一般人群中，MR患病率1%~3%WHO（1985）：輕度MR3%，重度3~4‰中國8省市0~14歲兒童（1988）：1.2%；農(nóng)村＞城市，男＞女湖南4~16歲兒童（1990）：2.22%整理課件病因遺傳性異常：常染色體隱性遺傳：如遺傳代謝性疾?。罕奖虬Y。常染色體顯性遺傳：結(jié)節(jié)性硬化癥，神經(jīng)纖維瘤病等。染色體畸變（結(jié)構和數(shù)目的改變）常染色體畸變：如DownSyndrome性染色體畸變：Klinefelter綜合征,Turner綜合征先天性顱腦畸形。整理課件母孕期有害因素的影響：

感染：如風疹病毒等

藥物與毒性物質(zhì)

放射線照射

母體健康情況

母親情緒因素

整理課件圍產(chǎn)期不利因素：早產(chǎn)、難產(chǎn)、產(chǎn)傷、窒

息、顱內(nèi)出血等

出生后不良因素：中樞神經(jīng)系統(tǒng)感染、外

傷、缺氧、內(nèi)分泌代謝疾病、嬰幼兒期嚴重營養(yǎng)不良、缺乏文化教育機會整理課件

MentalRetardationCauses

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

EstimatedCause ExamplesFrequency(%)整理課件MentalRetardationCauses

EstimatedCause Examples Frequency(%)Exposure 5.3Maternalinfections Congenitalrubella,HIVTeratogens FetalalcoholsyndromeToxemia,placental PrematurityinsufficiencyOther Radiation,trauma整理課件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整理課件分級按IQ水平分：輕度：50~69；中度：35~49；重度：20~34；極重度：IQ＜20。整理課件輕度MR（75~80%）：IQ50~69。語言功能較好，

抽象思維、綜合分析能力

較差；勉強小學畢業(yè)。日

常生活自理，可學會一技

之長。

中度（12%左右）：IQ35~49。語言發(fā)育較差詞

匯貧乏，不能完整表達思；

數(shù)的概念模糊，不能計和

點數(shù)；學習能力低下。學

會簡單的生活和工作技能，

常需要別人幫助。常有體

異常。

整理課件重度（7~8%）：IQ20~34。只能學會一些簡單的

語言，有的不會說話；經(jīng)過訓練，

能學會自己吃飯及基本衛(wèi)生習慣，

只能在監(jiān)護下生活，不能進行生

產(chǎn)勞動。從小可發(fā)現(xiàn)軀體及神經(jīng)

系統(tǒng)異常。

極重度（1~2%）：IQ20以下。無語言能力；對

周圍環(huán)境及親人不認識，僅

有原始情緒反應，以哭鬧尖

叫表需求食物或不樂意；全

部生活需要人照料，出生時

即有明顯的軀體畸形及神經(jīng)

系統(tǒng)異常。

整理課件診斷標準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標準差，在70以下社會適應能力不足起病于18歲以前整理課件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整理課件CASEFredwastheproductofanuncomplicatedpregnancyanddelivery.Developmentalmilestoneswereremarkableforwalkingat17monthsofage,butslownesstotalkandstammering,unclearspeech.Hewasdescribedasalittleslow,butat5yearsofagewhenverbalandlearningdelaysbecamemoreobvious,thefamilybecameconcerned.Atage6,Fredwasinjuredinanautomobileaccidentwithresultantcomafor5days.Hospitalrecordsatthetimesuggestedthepossibilityofslightneurologicalinjury,buthismotherattributedallofFred'ssubsequentproblemstothisaccident.Hewasunabletokeepupinschoolandfellintogreaterconflictwithhisyoungersiblings.At10yearsofagehedropped

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

CommonMeasuresofAdaptiveBehaviorMeasure AgeRange DomainsTestedVinelandAdaptiveBehaviorBirthto18 Communication:receptive,expressive,Scales(Sparrow,Balla,and written;dailylivingskills:personal,Cicchetti,1984) domestic;communitysocialization: interpersonalrelations,playandleisure; copingskills;motorskills:fine,gross整理課件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整理課件CommonMeasuresofAdaptiveBehaviorAAMRAdaptiveBehaviorScales3to18?Independentfunctioning,physicaldevelopment,(Lambert,Nihira,andLeland,1993) economicactivity,schoolKaufmanFunc