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Neuropeptides and neurotrophins in neonatal blood of children with autism or mental retardation.

There has been little exploration of major biologic regulators of cerebral development in autism. In archived neonatal blood of children with autistic spectrum disorders (n = 69), mental retardation without autism (n = 60), or cerebral palsy (CP, n = 63) and of control children (n = 54), we used recycling immunoaffinity chromatography to measure the neuropeptides substance P (SP), vasoactive intestinal peptide (VIP), pituitary adenylate cyclase-activating polypeptide (PACAP), calcitonin gene-related peptide (CGRP), and the neurotrophins nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin 3 (NT3), and neurotrophin 4/5 (NT4/5). Neonatal concentrations of VIP, CGRP, BDNF, and NT4/5 were higher (ANOVA, all p values < 0.0001 by Scheffe test for pairwise differences) in children in the autistic spectrum and in those with mental retardation without autism than in control children. In 99% of children with autism and 97% with mental retardation, levels of at least one of these substances exceeded those of all control children. Concentrations were similar in subgroups of the autistic spectrum (core syndrome with or without mental retardation, other autistic spectrum disorders with or without mental retardation) and in the presence or absence of a history of regression. Among children with mental retardation, concentrations did not differ by severity or known cause (n = 11, including 4 with Down syndrome). Concentrations of measured substances were similar in children with CP as compared with control subjects. SP, PACAP, NGF, and NT3 were not different by diagnostic group. No measured analyte distinguished children with autism from children with mental retardation alone. In autism and in a heterogeneous group of disorders of cognitive function, overexpression of certain neuropeptides and neurotrophins was observed in peripheral blood drawn in the first days of life.

Autistic Disorder↗

Family problem-solving with children who have mental retardation.

Problem-solving discussions were observed within families of children with mental retardation and multiple comparison groups (total N = 162 families). As expected, parents were more persistent and directive with their children who had mental retardation, but they also avoided negative exchanges with these children. These patterns did not spillover to interactions with the siblings, though older siblings of young children with mental retardation engaged in frequent negative exchanges with the parents. Irrespective of disability status, child behavior problems were associated with negative parent-child interactions. Also, high levels of family cohesion and independence and low levels of enmeshment and disengagement were associated with fewer negative parent-child exchanges, though these effects were less pronounced for interactions, specifically with children who have mental retardation.

Adolescent↗

The development of the interpersonal construct system in educable mentally retarded children.

The development of the interpersonal construct system of educable mentally retarded children was studied using three measures: cognitive complexity, construct abstractness and egocentricity. Ten mentally retarded children in the mental age groups of 6, 8, 10 and 12 were compared with nonretarded children of the same mental ages. The mentally retarded children used a limited number of constructs with less abstractness than the nonmentally retarded children. In terms of egocentricity, the nonretarded children used more other-oriented constructs than did the retarded children. For all measures, there were significant differences between the age levels of 6 and 8 versus 12 years, suggesting developmental trends.

Adolescent↗

Prevalence of the fragile-X syndrome in mentally retarded boys in a Swedish county.

In an etiological study of an unselected series of mentally retarded children (IQ less than 70) born 1959-1970 in a northern Swedish county, 12 of 205 boys (5.9%) were found to have a fragile site on the distal end of the C-chromosome (fra (X) (q27]. The incidence of the fra (X) syndrome was calculated to be 1:1500 boys in this county. If this is true for the whole of Sweden, 30-40 new cases of the fra (X) syndrome should be born yearly in Sweden. This must be considered a minimum figure, since a certain proportion of individuals with fra (X) are not observed in groups of mentally retarded patients. Next to trisomy 21, the fragile X syndrome is the most common specific cause of mental retardation among mentally retarded boys in Sweden.

Adolescent↗

Diurnal weight gain among patients with mental retardation.

We compared the diurnal weight gain of 46 patients with mental retardation to that of 21 patients with organic mental syndromes. They were weighed at 7 a.m. and 4 p.m. weekly for 3 weeks. We normalized the diurnal weight gain as a percentage by subtracting the 7 a.m. weight from the 4 p.m. weight, multiplying the difference by 100, and dividing the result by the 7 a.m. weight. Normalized diurnal weight gain was abnormal among one fourth of patients with mental retardation and two thirds of those with organic mental syndromes. Differences in age, sex, baseline weight, antipsychotic drugs, lithium, carbamazepine, blood pressure, and pulse did not explain our results. We believe that our findings provide additional evidence to separate patients with mental retardation from those with psychosis.

Adult↗

Development of the psychopathology instrument for Mentally Retarded Adults-Sexuality Scale (PIMRA-S).

Little research or attention has been focused on identifying sexual problems or difficulties that people with mental retardation commonly experience. Scale development represents an important area for study to help identify these problems and to evaluate treatment outcome. To address this need, the Psychopathology Instrument for Mentally Retarded Adults-Sexuality Scale (PIMRA-S) was designed to assess psychosexual disorders in mild and moderate mentally retarded persons. Eighty-six mild and moderately mentally retarded adults, ages 20 to 60, were studied using the PIMRA-S. Scale development of this type was considered important because little has been done to assess sexual problems among mentally retarded persons. Fifty-eight items were developed based on evaluations of the research literature and interviews of experienced professionals. A preliminary assessment of reliability was conducted. The psychometric characteristics of these preliminary analyses were favorable. In addition, information was reported on the rate of sexually aberrant behavior exhibited by people identified with mild and moderate mental retardation. Differences in the rate of sexually aberrant behavior were addressed as a function of living and work placement, positive history of sexual abuse, need for treatment of sexual problems, and psychiatric diagnosis. Implications of these results for further scale development are discussed.

Adult↗

Caries experience and oral hygiene status of blind, deaf and mentally retarded female children in Riyadh, Saudi Arabia.

OBJECTIVE: To determine the caries experience and oral hygiene status in blind, deaf and mentally retarded female children in Riyadh, Saudi Arabia. METHOD: All (N=218) the 6-7-year-old and 11-12-year-old blind, deaf and mentally retarded female children registered with the Presidency of Girls' Education schools in Riyadh were examined for dental caries and oral hygiene in a dental operatory setting. RESULTS: All (100%) the blind 6-7-year-old had caries with a mean dmft score of 6.58 (SD 2.02). The caries prevalence in blind 11-12-year-olds was 88.2% with a mean DMFT score of 3.89 (SD 2.67). Among 6-7-year-old blind children 8.3 %, and in 11-12-year-old blind children 29.4% had good oral hygiene. The caries prevalence in deaf 6-7-year-olds was 95.7% with a mean dmft score of 7.35 (SD 3.51). The caries prevalence in 11-12-year-old deaf children was 93% with a mean DMFT of 5.12 (SD 3.45). Less than one-fifth (17.4%) of the 6-7-year-old deaf children and only 7.0% of 11-12-year-old deaf children had good oral hygiene. The caries prevalence in mentally retarded 6-7-year-old was 93.9% with a mean dmft of 8.00 (SD 4.1). All the mentally retarded 11-12-year-old had carious teeth with a mean DMFT score of 5.81 (SD 2.95). Only 3.1% of the mentally retarded 6-7-year-old and none of the mentally retarded 11-12-year-olds had good oral hygiene. CONCLUSIONS: Caries prevalence and severity in all the three groups of female special children were very high, and the number of children with good oral hygiene was very low.

Blindness↗

Determining the capability of individuals with mental retardation to give informed consent.

Interviews were conducted for individuals without mental retardation and with mild or moderate mental retardation in order to determine their capability to provide informed consent to hypothetical treatment vignettes. Protocols were developed to permit structured interviews, and standardized scoring procedures were devised to provide reliable determinations. Use of these procedures resulted in highly reliable ratings across different clinicians, and the likelihood of being determined capable to provide consent was positively related to level of intellectual functioning. Results point to the need to educate individuals with mental retardation about treatment situations and to balance protection from harm with self-determination.

Clinical Protocols↗

Projections of a rebound in frequency of mental retardation from phenylketonuria.

The present decade marks the end of a unique generation--when the public benefited from the prevention of mental retardation phenylketonuria (PKU) without having to deal fully with the problems which can be anticipated from the reproduction of successfully treated, phenylketonuric individuals. The dysgenic effect (increase in prevalence of the PKU gene) from this reproduction will have negligible influence on the frequency of mental retardation from PKU over the next few centuries. In contrast, a dysgenic effect from maternal PKU will cause a rebound in frequency of mental retardation within this decade. Failure of the PKU programs as a result of maternal PKU, could affect the public attitude toward programs for the study and prevention of mental retardation and genetic diseases. Minimizing and explaining the rebound in frequency of mental retardation will be a difficult but necessary task for workers in the field of mental retardation.

Adolescent↗

Stress experienced by mothers of Malaysian children with mental retardation.

OBJECTIVE: To compare parenting stress among Malaysian mothers of children with mental retardation and a control group, and to determine factors associated with stress. METHODOLOGY: Seventy-five mothers of children with mental retardation aged 4-12 years and 75 controls (those without disabilities who attended the walk-in paediatric clinic) participated in the Parenting Stress Index (PSI). Intelligence quotient (IQ) and Child Behaviour Checklist (CBCL) scores, together with sociodemographic data, were entered into a multiple stepwise regression analysis, using the PSI as the criterion. RESULTS: Mothers of children with mental retardation scored significantly higher than control subjects in both the child-related domain (difference between means 26.1, 95% confidence interval 19.6-32.5) and parent-related domain (difference between means 15.0, 95% confidence interval 7.9-22.1) of the PSI. The total child behaviour scores from the CBCL (P < 0.01), IQ scores (P < 0. 01) and sibship size (P < 0.01) were associated with child-related domain scores. For the parent-related domain, CBCL (P < 0.01) and IQ scores (P = 0.01) remained important factors but Chinese ethnicity (P < 0.01) and maternal unemployment (P < 0.01) were also significant predictors of stress. CONCLUSION: A large proportion of mothers of children with mental retardation experienced substantial parenting stress, especially Chinese and unemployed mothers, and this warrants appropriate intervention.

Analysis of Variance↗

Implicit learning in children and adolescents with mental retardation.

The literature on implicit learning in persons with mental retardation is scarce and contradictory with respect to the relationship between degree of intellectual disability and impact of implicit-learning processes on performance. We examined children and adolescents with mild or moderate mental retardation and typically developing children matched on MA with regard to their implicit learning. Individuals with mental retardation modified their behavior after an implicit training procedure in a way similar to MA- or CA-matched controls. The impact of implicit learning did not vary as a function of IQ or age. However, some differences appeared between groups in their explicit remembering of the training conditions. The theoretical implications of these results are discussed.

Adolescent↗

Marker X-associated mental retardation. A study of 150 retarded males.

One hundred and fifty male patients with mental retardation of unknown origin were studied cytogenetically. Six patients (4%) were marker X-positive. All these index cases were found in a subgroup of patients with no dysmorphic features, significant neurological findings or childhood psychosis. In this subgroup the frequency was 8.8%. One of the index cases had a family history suggestive of X-linked mental retardation, four had retarded 1st degree relatives and one had no family history of mental retardation.

Adolescent↗

Low birthweight and the risk for mental retardation later in childhood.

Data from the population-based Metropolitan Atlanta Developmental Disabilities Study were used in a case-control study to assess the association between low birthweight and mental retardation (intelligence quotient < or = 70) among 10-year-old children who were born in 1975 or 1976. Children with mental retardation were identified from existing records at multiple sources and control children were selected from public school rosters. Data on birthweight and other covariates (sex, birth order, maternal age, maternal race, maternal education and gestational age) came from birth certificates. We used multiple logistic regression modelling to obtain adjusted odds ratios for mental retardation, with normal birthweight children (those weighing > or = 2500 g) as the referent group. For low birthweight children as a whole, the odds ratio for mental retardation was 2.8 (95% CI 1.9-4.2). The risk was higher for very low birthweight (< 1500 g) children than for moderately low birthweight (1500-2499 g) children, and higher for severe mental retardation (intelligence quotient < 50) than for mild mental retardation (intelligence quotient 50-70). Adding gestational age to the models revealed that normal birthweight children who were born preterm also were at increased risk of having mental retardation at age 10 years.

Birth Weight↗

Diagnosis and treatment of psychiatric and behavioural disorders in mentally retarded individuals: the state of the art.

It is now well known that a higher proportion of people with mental retardation show behavioural and psychiatric disorders compared to their non-mentally retarded counterparts. However, the exact relationship between psychiatric illness and behavioural disorder in this population is far from clear. There are problems of using the standard diagnostic and classification categories in this population, particularly in those who are severely and profoundly mentally retarded. Recently, there have been many novel approaches to this diagnostic dilemma, including 'developmental approach' and 'psychodynamic approach'. In the Netherlands, the so-called 'developmental-dynamic' approach has been used in the diagnosis and treatment of behavioural and psychiatric disorders in the mentally retarded. There have also been many treatment approaches, including drug therapy, behavioural treatment, psychotherapy, cognitive and social learning. Also the Dutch, Swiss and German traditions have extensive experience in the directive pedagogical treatment of the mentally retarded.

Combined Modality Therapy↗

The ARX story (epilepsy, mental retardation, autism, and cerebral malformations): one gene leads to many phenotypes.

PURPOSE OF REVIEW: Infantile spasms, mental retardation, autism, and dystonia represent disabling diseases for which little etiologic information is available. Mutations in the Aristaless related homeobox gene (ARX) have been found in patients with these conditions. This discovery provides important genetic information and may ultimately offer treatment options for these patients. RECENT FINDINGS: Recent work has demonstrated that mutations in ARX cause X-linked West syndrome, X-linked myoclonic epilepsy with spasticity and intellectual disability, Partington syndrome (mental retardation, ataxia, and dystonia), as well as nonsyndromic forms of mental retardation. Patients with these aforementioned diseases and ARX mutations were not reported to have brain imaging abnormalities. In contrast, mutations in ARX mutations have also been found in X-linked lissencephaly with abnormal genitalia, which typically includes severe brain malformations (lissencephaly, agenesis of the corpus callosum, and midbrain malformations), intractable seizures, and a severely shortened lifespan. ARX knockout mice manifest defects in overall neuroblast proliferation as well as selective abnormalities in gamma-aminobutyric acid-ergic interneuron migration. Consistent with these findings in mice, phenotype/genotype studies in humans suggest that truncating mutations cause X-linked lissencephaly with abnormal genitalia, and insertion/missense mutations result in epilepsy and mental retardation without cortical dysplasia. SUMMARY: Mutations in the homeobox gene, ARX, cause a diverse spectrum of disease that includes cognitive impairment, epilepsy, and in another group of patients severe cortical malformations. Although the precise prevalence of ARX mutations is unclear, ARX may rival Fragile X as a cause of mental retardation and epilepsy in males.

Animals↗

OBSERVATIONS ON COMMUNITY SCHOOL FACILITIES FOR THE MENTALLY RETARDED AND ADMISSIONS TO INSTITUTIONS IN ONTARIO, 1954-63.

The relationship between community school facilities and first admissions of mentally retarded children to Ontario Institutions was investigated for the period 1954-1963. The number of educable (I.Q. 50-75) mentally retarded children aged 6-16 years in community schools rose consistently (92.1/100,000 population in 1954 to 190.1 in 1963), while first admissions of educable mentally retarded persons aged 5-19 years to Ontario Hospital Schools showed no consistent trend (2.0/100,000 in 1954 and 2.0 in 1963). The number of trainable (I.Q. 20-50) mentally retarded children aged 5-18 years in community retarded children's schools rose steadily (10.9/100,000 population in 1954 to 42.8 in 1963), while first admissions in this category aged 5-19 years demonstrated no consistent trend (2.6/100,000 in 1954 and 2.2 in 1963).No indication was found that the age distribution of these first admissions had changed from 1954 to 1963. Any effect that increased school facilities might have had in reducing first admissions may have been nullified by the very large demand for a limited number of beds.

Adolescent↗

[Prevention of mental retardation].

OBJECTIVE: To present within the general field of the conditions causing mental retardation, the preventive strategies for specific application available at the present time. DEVELOPMENT: In spite of the fact that in the majority of cases of mental retardation the etiology is unknown, and for that reason, in them it is not possible to establish preventive strategies, within the last three decades, important research advances have helped to prevent thousands of cases of mental retardation of illnesses caused by Haemophilus influenzae B, measles encephalitis, Rh disease and severe jaundice in newborn infants, congenital hypothyroidism, phenylketonuria and congenital rubella; as well as removing lead from the environment, intervention programs for the proper use of seat belts, child safety seats, and motorcycle and bicycle helmets; early and adequate prenatal care, dietary supplementation with folic acid beginning before conception to reduce the risk of neural tube defects, avoidance of toxic substances during pregnancy like alcohol, and the use of newborn screening tests. CONCLUSION: The primary and secondary prevention of conditions that cause mental retardation continue being a challenge. Require of a review of the present strategies, that frequently inform about the problem, but are not practice in an every day bases (ej. intake of alcohol during pregnancy, the universal use of seat belt and child safety seats during automobile travel). In the future we may have the possibility of prenatal gene therapy.

Central Nervous System Infections↗

Refined 2.7 centimorgan locus in Xp21.3-22.1 for a nonspecific X-linked mental retardation gene (MRX54).

Nonspecific X-linked mental retardation (MRX) is a heterogeneous condition in which mental retardation (MR) appears to be the only consistent manifestation. A large genetic interval of assignment obtained on individual families by linkage analysis, genetic, heterogeneity, and phenotypic variability usually are major obstacles to fine-map and identify the related disease genes. Here we report on a large Tunisian family (MRX54) with an MRX condition. X-linked recessive inheritance is strongly suggested by the segregation of MR through seven unaffected carrier females to 14 affected males in two generations. Two-point linkage analysis demonstrated significant linkage between the disorder and several markers in Xp21.3-22.1 (maximum LOD score Zmax = 3.56, recombination fraction 0 = 0 at DXS1202), which was confirmed by multipoint linkage analyses. Recombinant events observed with the flanking markers DXS989 and DXS1218 delineate a refined locus of approximately 2.7 cM in accordance with the physical distance between these two markers. The small interval of assignment observed in this family overlaps not only with nine large MRX loci previously reported in Xp21.3-22.1 but also with two inherited microdeletions in Xp21.3-22.1 involved in nonspecific MR. Although the involvement of several genes located in the Xp21.3-22.1 region cannot be ruled out, data reported in this study could be used as a starting point for the search of such gene(s).

Adolescent↗