1. Assessment and diagnosis of children with intellectual disability
1.1, Clinical features.
Mental retardation, also known as mental retardation, MR, or mental retardation, is a syndrome that can be caused by a variety of causes of brain development disorders, characterized by mental retardation and social adaptation difficulties, can be accompanied by some kind of mental or physical disease. It starts during the developmental period and progresses slightly with age, but moderate and severe cases still pose a heavy burden to the family and society.
Diagnostic criteria for mental retardation in the Chinese Classification and Diagnostic Criteria for Mental Disorders, Second Edition.
1. the onset of the disease is at the developmental stage, i.e. 18 years old or before.
2. Significantly lower intellectual level than normal children of the same age, i.e. IQ, below 70.
3, social adaptation ability is significantly weaker than that of children of the same age with the same cultural background.
Diagnostic criteria for mild mental retardation.
1, IQ of 50 to 69.
2, no significant speech impairment.
3, learning ability can not successfully complete primary education, can learn certain livelihood skills.
Diagnostic criteria for moderate mental retardation.
1, IQ 35 to 49.
2.Ability to master the language of daily life, but poor vocabulary.
3.Can’t adapt to normal school study, but can learn to take care of themselves and simple work.
Diagnostic criteria for severe mental retardation.
1.IQ 20-34.
2.Severely impaired speech function, unable to communicate effectively in language.
3.Inability to take care of oneself in life.
Diagnostic criteria for very severe mental retardation: 1.
1, IQ below 20.
2.Lack of speech function.
3.Completely unable to take care of himself/herself.
Borderline intelligence.
1, IQ of 70 to 84.
2, abstract thinking ability is reduced, the breadth, depth and sensitivity of thinking is poor.
3.Inability to complete advanced and complex mental work.
1.2, evaluation methods
1.2.1. Intelligence test
1.2.1.1 Wechsler Intelligence Scale: prepared by the American psychologist Wechsler, and revised by Gong Yao Xian and others in China.
There are three kinds: one is the Wechsler Adult Intelligence Scale WAIS, for adults over 16 years old; the second is the Wechsler Intelligence Scale for Children WISC, for ages 6 and a half to 16 years and 11 months; the third is the Wechsler Preschool and Young Child Intelligence Scale WPPSI, for ages 4 years to 6 years and 9 months.
Scoring method: Each subject’s scores on each subtest were refined and finally converted into a scale score with 10 as the mean and 3 as the standard deviation, and then the verbal scale score, operational scale score, and total scale score were calculated based on the scale score of each subtest, according to which the equivalent IQ was found in the corresponding IQ scale according to the subject’s age, i.e., verbal IQ VIQ, operational IQ PIQ, and total IQ FIQ.
The mean score was IQ100 with a standard deviation SD, of 15. Low intelligence was defined as IQ values two standard deviations below the mean.
1.2.1.2 Stanford-Binet Intelligence Scale (S-B): The revised version in China is called “China Binet Scale”. It is applicable to ages 2 years to adults.
It includes four subscales and 15 subtests: verbal reasoning, abstract/visual reasoning, quantitative reasoning, and short term memory.
The results are expressed as standard scores, with a mean age score of 100 and a standard deviation of 16 for the whole scale.
1.2.1.3 Raven Progressive Matrices, RPM, consists of a series of pattern items, where each pattern is missing a part and the participant is asked to fill in the missing part by choosing one of eight or six similar alternative fragmented pictures.
There are three levels of versions: 1) Color Progressive Model CPM,: for children aged 5-11 years and those with low intelligence; 2) Standard Progressive Model SPM,: for the general population aged 6 years and older; 3) Advanced Progressive Model APM,: for those aged 11 years and older with average and above average intelligence.
Achievements are expressed as percentages. Compared with the percentile norm of the same age group, percentile above 95% is high level intelligence; 75-95% is above average intelligence; 25-74% is average intelligence; 5-24% is below average; below 5% suggests possible mental deficiency.
1.2.2 Developmental scales
1.2.2.1 Bayley Scales of Infant Development (BSID): prepared by Nancy Bayley in 1969 and revised by China in 1992.
It is used for individual testing to assess the level of cognitive function, motor and social skills development of infants aged 2 months to 30 months, to determine the degree of deviation from normal levels, and to diagnose developmental delays.
It is divided into three parts: a psychological scale, a motor scale, and an infant behavior record.
1.2.2.2 Gesell Development Diagnosis Scale (GDDS): Developed by Gesell, a pediatrician at Yale University School of Medicine, and his colleagues, and revised in China in 1985 and 1992.
It is applicable to ages 4 weeks to 6 years.
It includes five behavioral domains: adaptive behavior, gross motor behavior, fine motor behavior, verbal behavior, and personal-social behavior. The developmental quotient DQ, was calculated for each domain based on the relationship between the scores obtained in the five behavioral domains and the actual age.
1.2.2.3 Denver Developmental Screening Test (DDST, for short): Applicable from 2 months to 6 years of age, the purpose of the DDST is to detect early which children are highly likely to have developmental delays or abnormalities.
There are 105 items covering four areas of behavior: personal social skills, fine motor, gross motor, and language. The three levels of normal, suspicious and abnormal were classified according to the total score.
1.2.3 Adaptive Behavior Rating Scale
1.2.3.1 Life Skills Scale for Infants and Junior High School Students: It is a revised version of the Japanese S-M Social Life Skills Examination in Beijing in 1988.
It is used to assess the social life skills of children from 6 months to 15 years old and to assist in the diagnosis of mental retardation.
The scale is divided into six domains: independent living ability, motor ability, vocational ability, communication ability, socialization, and self-management.
1.2.3.2 Adaptive Behavior Rating Scale for Children: It was developed in 1990 for children aged 3-12 with normal or low intelligence. There are 59 items in the scale, divided into three factors and eight subscales: independent function factor, cognitive function factor, and social/self-control factor.
2. Rehabilitation of children with intellectual disabilities
2.1. Etiological treatment The principles of treatment are early detection, early diagnosis, identification of causes, and early intervention.
1. phenylalaninuria: low-phenylalanine diet.
2. galactosemia: discontinue dairy and replace it with rice flour or soy milk, add vitamins and inorganic salts.
3. branched-chain ketonuria: valine, leucine and isoleucine free diet.
4. homocystinuria: low methionine diet and large amounts of vitamin B6 and folic acid.
5. propionic acidemia: methionine-free, valine, leucine, isoleucine diet with high doses of biotin
6. endemic cretinism: thyroxine.
7. hepatomegaly: penicillamine.
8, obstructive hydrocephalus: drainage surgery.
2.2. Modern medical rehabilitation
2.2.1. Cognitive training
Cognitive training summary table
Item
Training methods
Sensation is the response to individual properties of things: perception is the response to individual properties of things as a whole. Sensation is the source of perception and all other knowledge.
Sight: to gaze and follow with both eyes. Use toys to induce children to follow with their eyes.
Use the eyes to follow something in a plastic tube. Use a transparent plastic tube filled with water and colored balls and move it back and forth to train children’s eyes to follow the small balls in the tube.
Color recognition: matching – sorting – selecting – naming – matching with other concepts
Hearing: listening to various sound directions.
Find the sound source and repeatedly change the direction, distance and intensity of the sound in order to continuously improve children’s sensitivity to sound and the speed of response in finding the sound source.
Tactile sensation: touching things with hands. Prepare some soft towels or harder wooden blocks, etc., so that children can distinguish what is soft and what is hard. Comparison of lightness, size, hot and cold.
Magic bag. Prepare several familiar objects into a cloth bag, so that children can reach into the pocket and grab one.
into the pocket and grab one, then touch it repeatedly. Through the shape and texture of the item, guess what the
Guess what is caught.
For children with mental retardation, training generally begins with unintentional training, allowing the child to fully develop his or her sensory perceptions, such as visualizing and tracking stimuli, and using auditory perception to capture and distinguish sounds, gradually increasing the range and duration of attention. After the child’s language development, the trainer can develop his ability to pay attention intentionally by regulating his cortical excitation centers with words and inhibiting the influence and interference of other irrelevant stimuli.
To train an inattentive child, first remind him repeatedly and use sound to guide his attention, especially when the trainer is teaching face-to-face, he can ask him: “Look at my eyes! This will help his attention, and he should be praised immediately for any slight progress.
Pleasant emotions can make children pay better attention to something during training, so use games as much as possible during training to keep children in a happy mood, and use magnifying glasses to see insects and listen to whispers to strengthen children’s attention.
Through repeated visual and auditory practice, the speed of temporary association is formed, thus improving the speed of memory.
To train short term memory ability, children are required to perform immediately according to the trainer’s verbal instructions; to train long term memory ability, more repeated recognition and recall are used to make children remember.
Visual: recognizing objects and pictures; fetching objects; quickly looking at pictures and saying the names of objects; literacy; remembering dance steps.
Auditory: reciting children’s songs; passing games.
What’s missing Prepare several toys or food items that children like and can name, let children look at them for a while, remove one of them, and ask them to say what’s missing.
Action thinking
Pull the rope to get things: Prepare 2-3 toys or food items that children like, tether them with different colors or different thicknesses of rope, put the toys that are not tethered to the place where they can’t reach, and put the rope that is tethered to the toys in the place where they can easily reach, and encourage them to pull the rope to get the toys.
Image thinking
Shape board into and rotate: the shaped objects such as graphics, triangles, correctly into the prepared shape board to make a good variety of graphics board, in, when the child learns to correctly put in, horizontal rotation of the shape board 90 degrees or 180 degrees. Then let put the shape board into the corresponding holes.
Wooden beads categorization: Prepare three different shapes and colors of beads, four of each, and train children to categorize them accurately.
Set of buckets: prepare four different sizes of set of buckets, in order from large to small, let him set one by one, if necessary, demonstration or gesture guidance.
Geometric bucket game.
Picture classification: The trainer prepares some pictures according to the broad categories of fruits, vegetables, animals, and transportation, etc. First let the children recognize the objects on the pictures and let them classify the pictures into categories. For example, fruits include peaches, pears, bananas, and apples.
Recognize the missing objects: Make some homemade pictures of missing objects and train children to find out the missing parts.
Abstract thinking
Comparison of similarities and differences: Take some objects or pictures and train the child to recognize the similarities and differences, the trainer should suggest from them that the comparison can improve his observation and analysis.
Answer questions: Ask simple questions to help the child reason and make judgments, to inspire him to think, find answers, and guess riddles.
Social Behavior Training
Early social basic behavior training
1.Smile and vocalize to the image in the mirror. 2.Look at the mother’s face. 3.Imitate adults to clap and wave. 4.Imitate playing with toys. 5.Obey adults’ instructions. 6.Imitate adults to do simple chores. 7.Say “please” and “thank you” as instructed. 7. Say “please” and “thank you” as instructed.
Social interaction skills training
1 Imitate adult’s face 2 Hide and seek 3 Roll a ball 4 Entertain guests 5 Recognize own family members 6 Role play 7 Follow game rules 8 Talk with adults
Self-care skills training
Eating behavior training
1.Self-feeding solid food 2.Drink from the cup held by adults 3.Drink from the cup by themselves 4.Eat with a spoon 5.Use chopsticks
Toilet and bowel behavior training
1.Use words or gestures to indicate when defecating 2.Go to the toilet to defecate by themselves
Dressing and undressing behavior
1.Cooperate with adults in dressing 2.Take off shoes and socks 3.Put on shoes and socks 4.Unlock and fasten buttons 5.Put on clothes
Washing behavior training
Wash and dry their own hands, brush their teeth, wash their faces, comb their hair, comb their short hair
Attention
Small steps, repeated practice, procedure
2.2.2. Special education
Special education is the education of children with special needs aimed at achieving general and special training goals using general or specially designed curricula, teaching materials, teaching methods and forms of teaching organization and teaching equipment. At present, in China, special education refers to education for people with visual, hearing speech and intellectual disabilities and people with multiple disabilities.
2.2.2.1 Structured Education Treatment and Education of Autistic and Related Communication Handicapped Children, TEACCH,: is a curriculum and instruction designed for children with autism, which was developed by Mesibov of the University of North Carolina and It was developed by Professors Mesibov and Schopler of the University of North Carolina in the mid-1960’s and has been developed over many years of teaching experience. It has been widely adopted by parents and teachers of children with autism in the last decade.
The TEACCH program includes: diagnosis, evaluation, structured education, individual developmental planning, social skills training, vocational training, family and community programs, and parent training and counseling.
Features of TEACCH: 1. Highly structured physical environment; 2. Structured work schedule; 3. Institutionalized work; and 4. Visual structure.
2.2.2.2 Applied Behavior Analysis, ABA: The core part of the program is the task decomposition technique, DTT.
DTT technique main steps: 1, task analysis and decomposition; 2, decomposition task reinforcement training; 3, reward task completion; ④ cue and cue tapering; ⑤ interval. Use of reinforcers and reinforcement.
2.2.3. Music therapy: It is a way to restore, maintain or improve the physiological and psychological health of the individual through music, so that the individual
s mind and body to achieve good changes.
2.2.3.1 Orff music therapy: is based on the Orff music education system. The Orff music therapy method is used together with the Orff music education system: 1. the method of improvisation; 2. the method of combining music and language; 3. the method of combining music and body movement; 4. the use of special Orff instruments.
2.2.3.2 Music Behavior Therapy Methods: Write a behavioral function analysis based on the principles of behavior therapy in the Music Therapist’s Manual, identify target behaviors and target symptoms, and develop long-term goals, short-term goals, and daily schedules accordingly. The use of music cues the behavior so that the participant maximizes physical and mental engagement to obtain the best therapeutic effect.
2.2.4. Medication
2.2.4.1 Selective application of brain nutrients: Promote functional development of brain cells: brain rejuvenation, brain aminopeptide, r-aminotyrosine, folic acid, acetyl glutamine, brain activator, nerve growth factor, etc. can be used.
2.2.4.2 Symptomatic treatment: for epilepsy or convulsions, anti-epileptic drugs such as sodium valproate, dutasteride and luminal can be used; for excitement and agitation, Valium and haloperidol can be given; for obvious excitement and hallucinations, antipsychotic drugs such as chlorpromazine and fenadine can be used.
2.2.5. Neural stem cell transplantation therapy
2.3. Traditional medicine rehabilitation
2.3.1. Acupuncture therapy.
Selected areas: Jijiu needles: 1.5 inches in front and behind the hundred acupuncture points, + 5 frontal acupuncture points, one acupuncture point on each side of the midpoint of the line from the double-headed dimension point to the Shen Ting point, a total of five needles; with language disorders with the international standardized head acupuncture positioning of language one, two, three areas; poor balance function with the international standardized head acupuncture positioning of the balance area; poor fine motor with the international standardized head acupuncture positioning of the application area; motor dysfunction with The motor zone of international standardized cephalometric positioning. Method: Use 30-40 gauge 40mm long milli-needle, needle body and scalp at an angle of 15-30° to quickly enter the needle, pierce under the capillary tendon membrane, advance the needle parallel to the scalp to a certain depth, retain the needle for 4 hours during the retention period, twist the needle three times, twist the needle once every 30 minutes, each time twist the needle for 3-5 minutes, speed 180-200 rpm. Then use Han’s electro-acupuncture instrument energized treatment for 20 minutes.
Treatment: Needle every other day, each needle 10 times, rest 15 days, needling 30 times for a course of treatment.
Caution: the amount of electroacupuncture stimulation should be small to large, according to the physical condition and sensitivity of each child; contraindicated for infants less than 6 months; cautiously used during the seizure period of the child; prevent dizziness during the treatment.
2.3.2. See the section on language rehabilitation for the method of awakening the brain and opening the mind.
2.3.3. Water acupuncture therapy.
Main acupuncture points: select Mute Gate, Kidney Yu, Foot San Li, Neiguan, Shen Men, Dazhi, Feng Chi, etc.
Method: select 3-4 acupoints each time, inject 1ml of medicinal solution into each acupoint, inject musk injection into head acupoints, and choose vitamin B1, vitamin B12 and salvia injection into trunk and limb acupoints.
The course of treatment and precautions: every other day, every 10 injections, rest 10 – 15 days, a total of 30 times a course of treatment, G6PD deficiency patients are prohibited musk injection, the rest of the same movement disorder rehabilitation section.
2.3.4. Chinese medicine: choose to use musk injection for sedation and oral treatment such as low intelligence rehabilitation pill.
2.3.5. Tuina method.
This method by pointing and pressing the corresponding acupuncture points on the head and torso, to achieve the effect of unblocking the qi and blood meridians on the head and face, regulating the five viscera and six internal organs, and regulating the two channels of Ren and Du, so as to achieve the purpose of awakening the brain, brightening the eyes and enhancing the physical fitness.
Technique: Use the interphalangeal joints of the thumbs or finger belly to press the corresponding acupuncture points with gentle and moderate strength, so as not to cause pain to the child
The strength should be moderate, so as not to cause pain or crying.
Head: Shenting, Benshin, Baihui, Sishencong, Brain Household, Mute Gate, Fengchi, mainly for waking up the brain and educating the mind.
Face: Ren Zhong, Di Cang, Cheek Cheeks, Cheng Jiao, Lian Quan, mainly to improve speech, salivation and mastication.
Chewing and swallowing disorders.
Around the eyes: sun, fish waist, eye-mind, Zanzhu, Chengwu, Sibai, mainly to improve visual impairment.
Around the ears: Ear Gate, Hearing Palace, Hearing Society, Cataract, Complete Bone, mainly to improve hearing disorders.
Back: Lung Yu, Heart Yu, Liver Yu, Spleen Yu, Stomach Yu, Kidney Yu, which mainly regulate the function of the internal organs.
Ren and Du: Tanzhong, Zhongyuan, Guanyuan, Qihai, Dazhi, Zhiyang, Jiujiao, Zhongshu, Lifemen, Lumbar Yangguan.
The main function is to unblock the Ren and Du channels, regulate the flow of Qi and blood throughout the body, improve the weakness of the waist and abdomen, and improve the ability to move around.
The acupuncture points of Laogong, Daling, Neiguan, and Zhanyuan on the Heart meridian, and Shenmen and Tongli on the Heart meridian, serve to awaken the mind and educate the mind.
2.4. Family medicine rehabilitation: including self-care training, early education, cognitive and intellectual development, etc.
Generally, the training staff instructs the parents how to train the child, and then the parents are the main teachers to train. It is more effective when combined with the training center to receive training.