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Behavioral development, DQ, IQ G SRINATH
Introduction ,[object Object],[object Object],[object Object]
Gross Motor Age in months Activity 3 Neck holding 5 Roll over 6 Sits with support 8 Sits without support, crawling,  9 Stands with support 12 Creeps, walks but falls, stands without support 15 Walks alone, creeps upstairs 18 Running 24 Walks stairs 2 feet at a time 36 Walks up stairs alternate feet, rides tricycle 48 Walks down stairs alternate feet, hopping
Fine Motor Age in months Activity 4 Bidextrous reach 6 Unidextrous reach and transfer, biscuit to mouth (Mouthing) 9 Immature pincer 12 Mature pincer, feeds from cup with spilling 15 Imitates Scribbles,  2 blocks, picks up glass and drinks  18 Scribbles, 3 blocks, feeds with spoon without spilling 24 Copies straight line, 6 blocks 36 Copies circle 48 Copies plus 60 Copies triangle 72 Copies rectangle 84 Copies diamond
Language Age in months Activity 1 Alerts to sounds 3 Cooing 4 Laughs aloud 6 Mono syllables 9 Bi syllables 12 1-2 words with meaning 18 8-10 words 24 2 word sentences 36 Gender identity, full name 48 Story telling, songs, poems 60 Asks meaning of words
Personal Social skills Age in months Activity 2 Social smile 3 Recognizes mother 6 Stranger anxiety 9 Waves bye-bye 12 Plays ball game 18 Copies parents in task 24 Asks for food 36 Shares toys 48 Plays in a group 60 Dressing, undressing, shoe lace tying
Developmental Quotient ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
DQ
Intelligence Quotient ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
MENTAL RETARDATION/ INTELLECTUAL DISABILITY G SRINATH
Definitions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
AAIDD- 2002 definition ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
DSM IV TR (2000) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ICD 10 ,[object Object],[object Object],[object Object],[object Object]
History ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
History ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Classification Degree of MR with IQ  Adult attainment Mild (50-69) 85% Literacy ++ (6 th  grade)- educable Self-help skills ++ Good speech ++ Semi-skilled work + Moderate (35-49) 10% Literacy + (2 nd -3 rd  grade) Self-help skills ++-Trainable Domestic speech + Unskilled work with or without supervision + Severe (20-34) 3-4% Assisted self-help skills + Minimum speech + Assisted household chores + Profound (Below 20) 1-2% Speech: Utterances of words +/- Self-help skills +/- Sensory- motor impairments+
Prenatal causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],Prenatal causes
Perinatal causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Postnatal Causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Associated Psychiatric problems  (Dual Diagnosis) ,[object Object],[object Object],[object Object],[object Object],[object Object]
Psychiatric illness in ID ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Psychiatric illness in ID
Behavioral phenotypes ,[object Object],[object Object],[object Object],[object Object]
Behavioral phenotypes: Examples Behavior Syndrome Hyperphagia, obsessions & compulsions, skin-picking Prader-Will syndrome Hand-wringing Rett syndrome Self mutilation  Lesch-Nyan syndrome  Inappropriate laughter Angelman syndrome Cat cry Cri-du-chat syndrome Social anxiety, gaze aversion Fragile X syndrome Psychosis VCFS, Prader-Willi Syndrome
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mental retardation and Psychosis  ,[object Object],[object Object]
Mental retardation and Psychosis (cont) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mental retardation and Affective disorders ,[object Object],[object Object],[object Object],[object Object]
Mental retardation and Affective disorders (Cont) ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Instruments specific to this population: ,[object Object],[object Object],[object Object],[object Object]
Common Associated Physical Problems ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Important clinical questions  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical evaluation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
Common syndromes Syndrome Key features Downs syndrome Typical facies, short stature, slanting eyes, simian crease, cup-shape ears, clinodactyly, CHD,  Fragile X syndrome Elongated triangular face, protruding or prominent ears, macro-orchidism Angelman syndrome Dysmorphic face - wide mouth, large tongue, thin upper lip, seizures, ataxia   Prader-Willi syndrome Obesity,  short stature, small hands/ feet, hypotonia Tuberous sclerosis Sebaceous adenomas, ash-leaf macules, shagreen patches
Common syndromes Syndrome Key features MPS I& II Typical facies, coarse skin, skeletal anomalies, corneal clouding, hepatosplenomegaly Phenylketonuria Light colored hair, abnormal smell of urine, microcephaly and seizures Autosomal recessive microcephaly Severe congenital microcephaly with mild to mod MR Rubinstien Taybi syndrome Prominent beak-shaped nose, broad thumb and hallux Cong Hypothyroidism Lethargy, growth failure, coarse and dry skin, constipation, feeding problems, prominent abdomen, bradycardia
Course and Prognosis
[object Object],[object Object]
Management principles ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Management principles (Cont) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Management
Investigations ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Investigations
Pharmacotherapy  ,[object Object],[object Object],[object Object],[object Object]
Pharmacotherapy (Cont) ,[object Object],[object Object],[object Object],[object Object],[object Object]
Some guidelines while starting a medication: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pharmacotherapy (Cont) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pharmacotherapy (Cont) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Aggression and its various causes Medical illness Treat medical condition Pre-seizure irritability Anticonvulsants Mood disorders SSRIs or mood stabilizers Task related anxiety CBT and anti anxiety drugs Associated with delusions Anti-psychotics Inability to express needs Teach functional communication skills
BM Techniques for building new skills ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],BM Techniques for building new skills
BM techniques to eliminate unwanted behaviors ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],BM techniques to eliminate unwanted behaviors
References ,[object Object],[object Object],[object Object]
[object Object]

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High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 

Intellectual disability

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  • 3. Gross Motor Age in months Activity 3 Neck holding 5 Roll over 6 Sits with support 8 Sits without support, crawling, 9 Stands with support 12 Creeps, walks but falls, stands without support 15 Walks alone, creeps upstairs 18 Running 24 Walks stairs 2 feet at a time 36 Walks up stairs alternate feet, rides tricycle 48 Walks down stairs alternate feet, hopping
  • 4. Fine Motor Age in months Activity 4 Bidextrous reach 6 Unidextrous reach and transfer, biscuit to mouth (Mouthing) 9 Immature pincer 12 Mature pincer, feeds from cup with spilling 15 Imitates Scribbles, 2 blocks, picks up glass and drinks 18 Scribbles, 3 blocks, feeds with spoon without spilling 24 Copies straight line, 6 blocks 36 Copies circle 48 Copies plus 60 Copies triangle 72 Copies rectangle 84 Copies diamond
  • 5. Language Age in months Activity 1 Alerts to sounds 3 Cooing 4 Laughs aloud 6 Mono syllables 9 Bi syllables 12 1-2 words with meaning 18 8-10 words 24 2 word sentences 36 Gender identity, full name 48 Story telling, songs, poems 60 Asks meaning of words
  • 6. Personal Social skills Age in months Activity 2 Social smile 3 Recognizes mother 6 Stranger anxiety 9 Waves bye-bye 12 Plays ball game 18 Copies parents in task 24 Asks for food 36 Shares toys 48 Plays in a group 60 Dressing, undressing, shoe lace tying
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  • 10. MENTAL RETARDATION/ INTELLECTUAL DISABILITY G SRINATH
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  • 17. Classification Degree of MR with IQ Adult attainment Mild (50-69) 85% Literacy ++ (6 th grade)- educable Self-help skills ++ Good speech ++ Semi-skilled work + Moderate (35-49) 10% Literacy + (2 nd -3 rd grade) Self-help skills ++-Trainable Domestic speech + Unskilled work with or without supervision + Severe (20-34) 3-4% Assisted self-help skills + Minimum speech + Assisted household chores + Profound (Below 20) 1-2% Speech: Utterances of words +/- Self-help skills +/- Sensory- motor impairments+
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  • 26. Behavioral phenotypes: Examples Behavior Syndrome Hyperphagia, obsessions & compulsions, skin-picking Prader-Will syndrome Hand-wringing Rett syndrome Self mutilation Lesch-Nyan syndrome Inappropriate laughter Angelman syndrome Cat cry Cri-du-chat syndrome Social anxiety, gaze aversion Fragile X syndrome Psychosis VCFS, Prader-Willi Syndrome
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  • 39. Common syndromes Syndrome Key features Downs syndrome Typical facies, short stature, slanting eyes, simian crease, cup-shape ears, clinodactyly, CHD, Fragile X syndrome Elongated triangular face, protruding or prominent ears, macro-orchidism Angelman syndrome Dysmorphic face - wide mouth, large tongue, thin upper lip, seizures, ataxia Prader-Willi syndrome Obesity, short stature, small hands/ feet, hypotonia Tuberous sclerosis Sebaceous adenomas, ash-leaf macules, shagreen patches
  • 40. Common syndromes Syndrome Key features MPS I& II Typical facies, coarse skin, skeletal anomalies, corneal clouding, hepatosplenomegaly Phenylketonuria Light colored hair, abnormal smell of urine, microcephaly and seizures Autosomal recessive microcephaly Severe congenital microcephaly with mild to mod MR Rubinstien Taybi syndrome Prominent beak-shaped nose, broad thumb and hallux Cong Hypothyroidism Lethargy, growth failure, coarse and dry skin, constipation, feeding problems, prominent abdomen, bradycardia
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  • 53. Aggression and its various causes Medical illness Treat medical condition Pre-seizure irritability Anticonvulsants Mood disorders SSRIs or mood stabilizers Task related anxiety CBT and anti anxiety drugs Associated with delusions Anti-psychotics Inability to express needs Teach functional communication skills
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