Hello Amartin75,
First, I?m so sorry that you and your son are going through such an
uncertain and emotional time. I?m glad you are considering a second
opinion, and feel it is warranted. If your son is developmentally
delayed, the sooner an accurate diagnosis can be made, the sooner he
can receive appropriate help. There are several criteria to be met for
a diagnosis of mental retardation, along with chromosomal testing.
There are also numerous syndromes and levels of mental
retardation/developmental delays. A thorough evaluation along with
chromosomal testing should help you in your quest for a diagnosis. Has
your son?s hearing been tested? Vision? A blood test for lead is often
ordered in cases similar to your son?s. A child of three can be
diagnosed with mental retardation, but I found no references to
?temporary mental retardation?.
As far as a diagnosis of ?temporary mental retardation?, I suspect
what was meant was a temporary diagnosis, and that diagnosis was
mental retardation, pending a more in-depth evaluation. Now is the
time to get that complete evaluation. As you probably know, we are
unable to diagnose your son online. This answer is not intended to
diagnose, treat, or replace sound medical advice and testing.
According to the Merck Manual, ?Mental retardation is not a specific
medical disorder like pneumonia or strep throat, and it is not a
mental health disorder. A person with mental retardation has
significantly below average intellectual functioning that limits his
ability to cope with two or more activities of normal daily living
(adaptive skills). These activities include the ability to
communicate; live at home; take care of oneself, including making
decisions; participate in leisure, social, school, and work
activities; and be aware of personal health and safety.?
?However, most children with mental retardation do not develop
symptoms that are noticeable until the preschool period. Symptoms
become apparent at a younger age in those more severely affected.
Usually, the first problem parents notice is a delay in language
development. Children with mental retardation are slower to use words,
put words together, and speak in complete sentences. Their social
development is sometimes slow, because of cognitive impairment and
language deficiencies. Children with mental retardation may be slow to
learn to dress and feed themselves. Some parents may not consider the
possibility of retardation until the child is in school or preschool
and is unable to keep up with age-appropriate expectations.?
http://www.merck.com/mmhe/sec23/ch285/ch285a.html
?Starts before age 18.
Associated Features:
Under developed motor skills
Under developed language skills
Under developed self-help skills
Developing at a far slower rate than the child's peers.
Differential Diagnosis:
Some disorders have similar or even the same symptoms. The clinician,
therefore, in his/her diagnostic attempt, has to differentiate against
the following disorders which need to be ruled out to establish a
precise diagnosis.?
http://www.psychnet-uk.com/dsm_iv/mental_retardation.htm
?After a physician confirms the presence of a developmental delay or
disorder, parents have to contend with a range of emotions: grief,
disbelief, anger, hope, fear. Coming to terms with a child?s
developmental delay or disorder can be a lengthy process. While each
parent responds differently, many parents recall that the first steps
towards self-education and action proved crucial not only for the
child?s well-being, but for their own. The only magical formula for a
child?s best outcome is an active and involved parent. Spend time with
your child. You don?t need a degree in psychology to help your child.
Don?t hesitate to ask your child?s physician for help. And don?t be
afraid to lean on your family and friends. Beyond love and acceptance,
you will find that creativity and persistence are invaluable tools.
Speaking to parents of children diagnosed with disabilities, one theme
is clear: act now.?
http://www.firstsigns.org/treatment/index.htm
?What is early intervention?
Every state has an early intervention program that you will want to
get your child into right away. If you live in Michigan, your doctor
may refer you to the Early On Program in your local school district.
(Outside Michigan, you can find your state's early intervention
services through the NICHCY website.) Early On (and all states' early
intervention programs) offer many different services and will help set
up an individualized program for your family. It is called an
Individual Family Service Plan (IFSB).
? Find out all about how to access early intervention services for
babies, toddlers, and preschoolers. ["Accessing Programs for Infants,
Toddlers, and Preschoolers with Disabilities (ages 0-5)"]. You can get
this information in plain text, PDF, or in Spanish.
It is most important to start treatment as early as possible, and make
sure it involves lots of one-on-one interaction with your child.?
http://www.med.umich.edu/1libr/yourchild/devdel.htm
?Actually, in order to be diagnosed as a person with mental
retardation, the person has to have both significantly low IQ and
considerable problems in everyday functioning. Most children with
mental retardation can learn a great deal, and as adults can lead at
least partially independent lives. Most individuals with mental
retardation have only the mild level of mental retardation. Mental
retardation may be complicated by several different physical and
emotional problems. The child may also have difficulty with hearing,
sight or speech.?
?It is very important that the child has a comprehensive evaluation to
find out about his or her strengths and needs. Since no specialist has
all the necessary skills, many professionals might be involved.
General medical tests as well as tests in areas such as neurology (the
nervous system), psychology, psychiatry, special education, hearing,
speech and vision, and physical therapy are useful. A pediatrician or
a child and adolescent psychiatrist often coordinates these tests.
These physicians refer the child for the necessary tests and
consultations, put together the results, and jointly with the family
and the school develop a comprehensive treatment and education plan.
Emotional and behavioral disorders may be associated with mental
retardation, and they may interfere with the child's progress. Most
children with mental retardation recognize that they are behind others
of their own age. Some may become frustrated, withdrawn or anxious, or
act "bad" to get the attention of other youngsters and adults.
Adolescents and young adults with mental retardation may become
depressed. These persons might not have enough language skills to talk
about their feelings, and their depression may be shown by new
problems, for instance in their behavior, eating and sleeping.?
http://www.aacap.org/publications/factsfam/retarded.htm
Criteria:
=========
Although it can be defined objectively, developmental disability does
not represent a single condition. Some of the difficulties of
characterizing it more precisely are illustrated by comparing it to
the condition of short stature, with which it shares all of the
following characteristics:
? Diagnostic criteria are defined statistically and arbitrarily.
? There are many subgroups with distinguishable developmental patterns.
? It is not a single, homogeneous disease; there are many known
causes, both inherent and environmental, and congenital and acquired.
? Different diagnostic criteria are used for different purposes.
? More than one factor may contribute to disability for any one person.
? New conditions and causes are discovered or better understood each year.
? Treatments can be very effective, marginally beneficial, or
ineffective, varying by cause and age of intervention.
? For a significant proportion of affected people, a cause cannot be determined.
The limitations of cognitive function will cause a child to learn and
develop more slowly than a typical child. Children may take longer to
learn to speak, walk, and take care of their personal needs such as
dressing or eating. They will have trouble learning in school.
Learning will take them longer, require more repetition, and there may
be some things they cannot learn. The extent of the limits of learning
is a function of the severity of the disability.
There are three criteria before a person is considered to have a
developmental disability: an IQ below 70, significant limitations in
two or more areas of adaptive behavior (i.e., ability to function at
age level in an ordinary environment), and evidence that the
limitations became apparent in childhood. Down syndrome, fetal alcohol
syndrome and fragile X are the three most common inborn causes.
By most definitions, it is more accurately considered a disability
rather than a disease. It can be distinguished in many ways from
mental illness, such as schizophrenia or depression. There is no
"cure" for an established disability, though with appropriate support
and teaching most individuals can learn to do many things.?
http://www.mrsci.com/Childhood-Psychiatric-Disorders/Mental_retardation.php
?Question: ?My child has always been a little slow, but I?m not sure
if he has mental retardation. What is Mental Retardation exactly??
Answer: A diagnosis of mental retardation may be given if all
three of the following criteria may be satisfied:
? significantly sub-average intellectual functioning (an IQ of 70 or below)
? concurrent deficits or impairments in adaptive functioning
? onset before age 18 years.?
http://www.dallasmetrocare.com/FAQ/body_faq.html
?Alternative diagnoses list for Mental Retardation: For a diagnosis of
Mental Retardation, the following list of conditions have been
mentioned in sources as possible alternative diagnoses to consider
during the diagnostic process for Mental Retardation:
? Learning disorders (type of Mental illness)
? Reading disorder
? Communication disorder
? Pervasive developmental disorder
? Dementia
Mental Retardation as an alternative diagnosis: The other diseases for
which Mental Retardation is listed as a possible alternative diagnosis
in their lists include:
? Autism
? Communication disorders
? Dementia
? Landau-Kleffner Syndrome
? Learning disabilities
? Oppositional Defiant Disorder
? Pyromania
Medical news summaries about misdiagnosis of Mental Retardation: The
following medical news items are relevant to misdiagnosis of Mental
Retardation:
? Childhood with Fragile X
? New disorder discovered that causes adult tremors ?
http://www.wrongdiagnosis.com/m/mental_retardation/misdiag.htm
Another list of other possible disorders:
http://www.mental-health-matters.com/disorders/dis_category.php?catID=11
A short review of the different PDD's (Pervasive developmental disorder)
There are five types of PDD's.
A. Childhood autism
B. Asperger's syndrome
C. Childhood disintegrative disorder
D. Rett's disease
E. PDD NOS or pervasive developmental disorder not otherwise specified
http://www.childbrain.com/pddq4.shtml
http://www.childbrain.com/pddq1.shtml
?Mental retardation (MR) and other neurodevelopmental disabilities are
seen often in a general pediatric practice. Approximately 10% of
children are learning impaired, while as many as 3% manifest some
degree of MR. The population prevalence of these combined disorders of
learning rivals that of the common childhood disorder asthma.
MR originates during the developmental period (ie, conception through
age 18 years) and results in significantly subaverage general
intellectual function with concurrent deficits in functional life
skills. The diagnosis of MR requires an intelligence quotient (IQ)
score of at least 2 standard deviations (SD) below the mean IQ of 100
(ie, IQ <70). Equivalent deficits in at least 2 areas of functional
life skills or adaptive skills also must be present to meet the
diagnostic criteria for MR. Adaptive skills encompass functional life
skills within the domains of communication, self-care, home living,
social and interpersonal skills, use of community resources,
self-direction, functional academic skills, work, leisure, health, and
safety.?
? ?Developmental assessment
o For the diagnoses of developmental delay and MR, an expanded
neurologic examination (including cognitive assessment and
psychological tests) is required.
o For the purpose of screening, the physician can administer various
tests, including the Denver Developmental Screening Test-II, the
Capute Scales, the Slosson Intelligence Test, and the Vineland
Adaptive Behavior Scales.
o Key behavioral observations should focus on the child's
communicative intent, social skills, eye contact, compliance,
attention span, impulsivity, and style of play.
o A licensed psychologist can administer various psychological tests
to assess language comprehension, language expression, nonverbal
problem-solving abilities, fine motor and adaptive abilities,
attention span, memory, gross motor skills, and behaviors. The most
common psychological tests include the Bayley Scales of Infant
Development, the Stanford-Binet Intelligence Scale, the Wechsler
Intelligence Scale for Children-III, and the Wechsler Preschool and
Primary Scale of Intelligence-Revised.
? Physical examination
o Measurement of all growth parameters must include head
circumference. Microcephaly correlates highly with cognitive deficits.
Macrocephaly may indicate hydrocephalus and is associated with some
inborn errors of metabolism.
o Short stature may suggest a genetic disorder, fetal alcohol
syndrome, or hypothyroidism. Tall stature may suggest fragile X
syndrome (FraX), Soto syndrome, or other overgrowth syndrome
associated with MR.
o Major organ system abnormalities may direct the etiologic investigation.
o Cutaneous findings of etiologic interest include hyperpigmented and
hypopigmented macules (café-au-lait macules, hypomelanosis of Ito,
ash-leaf spots), fibromas, and irregular pigmentation patterns.
o Examine for subtle dysmorphic features.
o Although MR with multiple congenital anomalies and major
malformations (MR/MCA) accounts for only 5% of all cases of MR, the
majority of these affected individuals have 3 to 4 minor anomalies,
especially involving the face and digits.
There is a lot of information on this page, which I am unable to post
due to copyright restrictions. Please have a good look to get a feel
for all the diagnostic criteria.
You can find a chart illustrating categories and prevalence of mental
retardation on this site:http://www.emedicine.com/NEURO/topic605.htm
?Children with and IQ of 69 to 84 have difficulty in school learning
but are not mentally retarded. They are rarely identified before
beginning school, when educational and sometimes behavioral problems
become evident. With special educational help, they can usually
succeed in school and lead normal lives.
All children with mental retardation can benefit from education.
Children with mild retardation may attain fourth to sixth grade
reading skills. Although they have difficulty reading, most mildly
retarded children can learn the basic educational skills needed for
everyday life. They require some supervision and support and special
educational and training facilities. They may later require a
sheltered living and work situation. Though usually free or obvious
physical defects, people who are mildly retarded may have epilepsy.
The mildly retarded are often immature and unsophisticated, with a
poorly developed capacity for social interaction. Their thinking is
concrete and they are often unable to generalize. They have
difficulty adjusting to new situations and may demonstrate poor
judgment, lack of foresight, and gullibility. Although they don't
commonly commit serious offenses, the mildly retarded may commit
impulsive crimes, often as members of a group and sometimes to achieve
peer group status.
Children with moderate retardation are obviously slow in learning to
speak and reaching other developmental milestones, such as sitting up
and speaking. Given adequate training and support, mildly and
moderately retarded adults can live with varying degrees of
independence within the community. Some can cope with just a little
support in a halfway house, whereas others need greater supervision.
The severely retarded child is trainable to a lesser degree than a
child who is moderately retarded. The profoundly retarded child
usually can't learn to walk, talk or understand very much.
The life expectancy of children with mental retardation may be
shortened, depending on the cause and severity. In general, the more
severe the retardation, the shorter the life expectancy.?
http://www.everything2.com/index.pl?node=mental%20retardation
?Developmental Delay is when your child does not reach their
developmental milestones at the expected times. It is an ongoing,
major delay in the process of development. If your child is slightly
or only temporarily lagging behind, that is not called developmental
delay. Delay can occur in one or many areas?for example, motor,
language, social, or thinking skills.
Developmental Delay is usually a diagnosis made by a doctor based on
strict guidelines. Usually, though, the parent is the first to notice
that their child is not progressing at the same rate as other children
the same age. If you think your child may be ?slow,? or ?seems
behind,? talk with their doctor about it. In some cases, your general
pediatrician might pick up a delay during a well child visit or other
meetings. It will probably take several visits and possibly a referral
to a developmental specialist to be sure that the delay is not just a
temporary lag. Special testing can also help gauge your child's
developmental level.?
?What should I do if I suspect my child has developmental delay?
If you think your child may be delayed, you should take them to their
primary care provider, or to a developmental and behavioral
pediatrician or pediatric neurologist. An alternative to seeing a
specialist is to work through your local school system (see below). If
your child seems to be losing ground?in other words, starts to not be
able to do things they could do in the past?you should have them seen
right away. If your child is developmentally delayed, the sooner you
get a diagnosis, the sooner you can begin appropriate treatment and
the better the progress your child can make.
If you are concerned about your child's development, check out First
Signs, a website with information and resources for early
identification and intervention for children with developmental delays
and disorders. Explore the many resources for parents available on the
site.?
http://www.med.umich.edu/1libr/yourchild/devdel.htm
The above site links to this nice flow chart of diagnosing developmental delays:
http://www.firstsigns.org/images/SevenStepLg.gif
?Refer to Early Intervention and to specialist for further
developmental evaluation. When a developmental screening indicates a
possible delay, First Signs recommends that you refer the child to
Early Intervention and directly to a specialist (i.e., developmental
pediatrician, pediatric neurologist, psychiatrist, or psychologist)
for further developmental evaluation. (See the PDF version of the
First Signs brochure ?A Pediatric Practitioner's Guide: Referring a
Child to Early Intervention? a) outside panels, b) inside panels.?
http://www.firstsigns.org/screening/guidelines.htm
?The most recent change in the definition of mental retardation was
adopted in 1992 by the American Association on Mental Retardation.
"Mental retardation refers to substantial limitations in present
functioning. It is characterized by significantly subaverage
intellectual functioning, existing concurrently with related
limitations in two or more of the following applicable adaptive skill
areas: communication, self-care, home living, social skills, community
use, self-direction, health and safety, functional academics, leisure,
and work. Mental retardation manifests before age 18" (American
Association on Mental Retardation, 1992). On the surface, this latest
definition does not appear much different than its recent
predecessors. However, the focus on the functional status of the
individual with mental retardation is much more delineated and
critical in this definition.
There is also a focus on the impact of environmental influences on
adaptive skills development that was absent in previous definitions.
Finally, this revision eliminated the severity level classification
scheme in favor of one that addresses the type and intensity of
support needed: intermittent, limited, extensive, or pervasive.
Practically, a child under age 18 must have an IQ < 75 and deficits in
at least 2 of the adaptive behavior domains indicated in the
definition to obtain a diagnosis of mental retardation.?
?Four levels of mental retardation are specified in ICD-10: F70 mild
(IQ 50 - 69), F71 moderate (IQ 35 - 49), F72 severe (IQ 20 - 34), and
F73 profound (IQ below 20). IQ should not be used as the only
determining factor. Clinical findings and adaptive behavior should
also be used to determine level of intellectual functioning. Two
additional classifications are possible: F78 other mental retardation
and F79 unspecified mental retardation. Other mental retardation (F78)
should be used when associated physical or sensory impairments make it
difficult to establish the degree of impairment. Unspecified mental
retardation (F79) should be used when there is evidence of mental
retardation but not enough information to establish a level of
functioning (e.g., a toddler with significant delays in development
who is too young to be assessed with an IQ measure).?
http://www.uab.edu/cogdev/mentreta.htm
Should you live in one of these states, a First Signs program is
available to help you. Each state has a link to further information.:
? Alabama
? Delaware
? Minnesota
? New Jersey
? Pennsylvania
? Wisconsin
http://www.firstsigns.org/programs/programs.htm
I've included some information on Autism:
Autism
======
?The development of impairments in autistic persons is varied (Table
21) and characteristically uneven, resulting in good skills in some
areas and poor skills in others. Echolalia, the involuntary repetition
of a word or a sentence just spoken by another person, is a common
feature of language impairment that, when present, may cause language
skills to appear better than they really are. There may also be
deficiencies in symbolic thinking, stereotypic behaviors (e.g.,
repetitive nonproductive movements of hands and fingers, rocking,
meaningless vocalizations), self-stimulation, self-injury behaviors,
and seizures. Mental retardation is not a diagnostic criterion, but it
is frequently present in the moderate to severe range.?
http://www.aafp.org/afp/20021101/1667.html
?Dr. Frank Aiello III, a developmental pediatrician at Children's
Hospital of The King's Daughters in Norfolk, Va., says one of the
early signs of autism is delayed language development. For example, a
12-month-old baby who is not using "mama" and "dada" specifically for
his mom and dad or who does not point for the things he needs may have
a developmental delay. Additionally, an 18-month-old who doesn't have
a vocabulary of at least 10 words and who doesn't point to pictures in
books should be evaluated.?
http://toddlerstoday.com/resources/articles/autism.htm
?What Are the Autism Spectrum Disorders?
The autism spectrum disorders are more common in the pediatric
population than are some better known disorders such as diabetes,
spinal bifida, or Down syndrome.2 Prevalence studies have been done in
several states and also in the United Kingdom, Europe, and Asia.
Prevalence estimates range from 2 to 6 per 1,000 children. This wide
range of prevalence points to a need for earlier and more accurate
screening for the symptoms of ASD. The earlier the disorder is
diagnosed, the sooner the child can be helped through treatment
interventions. Pediatricians, family physicians, daycare providers,
teachers, and parents may initially dismiss signs of ASD,
optimistically thinking the child is just a little slow and will
"catch up." Although early intervention has a dramatic impact on
reducing symptoms and increasing a child's ability to grow and learn
new skills, it is estimated that only 50 percent of children are
diagnosed before kindergarten.
All children with ASD demonstrate deficits in 1) social interaction,
2) verbal and nonverbal communication, and 3) repetitive behaviors or
interests. In addition, they will often have unusual responses to
sensory experiences, such as certain sounds or the way objects look.
Each of these symptoms runs the gamut from mild to severe. They will
present in each individual child differently. For instance, a child
may have little trouble learning to read but exhibit extremely poor
social interaction. Each child will display communication, social, and
behavioral patterns that are individual but fit into the overall
diagnosis of ASD.?
http://www.nimh.nih.gov/publicat/autism.cfm
?In the case of children with autism spectrum disorders, the Practice
Parameter for the Screening and Diagnosis of Autism recommends ?a
comprehensive multidisciplinary approach,? which can include one or
more of the following professionals:
? psychologists
? neurologists
? pediatricians
? developmental pediatricians
? child psychiatrists
? speech-language pathologists
? occupational therapists
? physical therapists
? audiologists
? educators
? special educators
The composition of the ?team? is contingent on the presenting needs of
the child. Through observation, evaluation, and study, physicians and
parents can work together to identify the unique needs of each child.
Accordingly, any specialists involved and treatments implemented
should be determined by those unique needs. More detailed information
about each of these specialties can be found in our guest column,
?Putting together your child?s treatment team,? by author and parent
Mitzi Waltz.?
http://www.firstsigns.org/treatment/specialists.htm
?Some conditions may be confusingly similar to autism and one must be
careful when making a final determination about a child's disorder and
its management. Any condition that may be associated with language
delay, especially those that are treatable, must be considered.?
http://www.childbrain.com/pddq13.shtml
Lastly, ?What can a parent do next?
Once a child has a diagnosis, it may seem like the question marks
about a child?s development have been removed, and substituted by an
exclamation point. ?What is wrong?? may become ?Autism!? But parents
have to move beyond the name and begin to learn the rules of the
waiting game. Many programs and specialists have long waiting lists,
and progress often seems slow; however, parents can do many things in
the meantime.
? Use this time as an opportunity to study about the disorder. Read,
research, and re-invigorate.
? Contact the Autism Society of America (ASA) to start your research.
? If your child is receiving services from Early Intervention, use
those sessions as opportunities to learn. How is the specialist
engaging the child? What sort of activities are they doing, and why?
What might you be able to do at home?
? Explore home-based therapies which involve parent participation,
such as ?Floortime? (ICDL).
? Seek speech/language, occupational, physical, or other appropriate
therapies. Often, individual therapies (as opposed to programs,
centers, or some well-established specialists) have shorter waiting
lists.
? Find a local parent support group. You don?t have to ?share? if you
don?t want to; it may be helpful just to listen. Experienced parents
can give you resources, guidance, camaraderie, and above all,
perspective. Many parent groups also host training sessions, which
enable you to build upon your natural skills.
? Above all, become more involved with your child. While you may not
be able to ?cure? your child, your direct participation can play a
critical role in promoting your child?s healthy neurological
development. Get down on the floor and play: blow bubbles; try a
tickle; or, just sing and dance. Children with developmental
disorders, like all children, need loving and engaged caregivers to
open their minds and hearts to the world.?
http://www.firstsigns.org/treatment/next.htm
Additional Reading
==================
http://www.nichcy.org/resources/intro.asp
http://ibis-birthdefects.org/start/mentalSyndrome.htm
http://www.emedicine.com/NEURO/topic550.htm
http://www.vrri.org/cb1204/cv1204bk.pdf
http://www.emedicine.com/med/topic3095.htm
http://health.families.com/mental-retardation-2172-2176-gem
http://specialchildren.about.com/
I hope this has helped you seek adequate testing and treatment for
your son, and I wish you all the best. Most of the sites I have posted
have a great deal of good information, beyond what I am able to
include. Please spend some time reading further on each site.
If any part of my answer is unclear, please request an Answer
Clarification. I will be happy to assist you further, before you rate
my answer.
Sincerely, Crabcakes
Search Terms
=============
Differential diagnosis + mental retardation + children
Assessing mental retardation
Temporary + mental retardation
Diagnosing mental retardation + toddlers
Evaluating mental retardation + children |
