Patient's question:
Main symptoms: Hypoxia in utero, infant has no breathing at birthOnset time: Prenatal
Laboratory test results: Acidosis
Doctor's answer:
First, it should be determined whether there is MR based on IQ, adaptive behavior, and age of onset, and then further investigate the causes of MR.During the diagnostic process, detailed medical history of the child's growth and development should be collected, comprehensive physical and neuropsychological examinations should be conducted. Growth and development indicators of children at different ages and stages should be compared with those of normal peers of the same age to determine their intellectual level and adaptive ability, and make clinical judgments. At the same time, appropriate intelligence testing methods should be used to make a diagnosis and determine the severity of MR.
1. Medical history collection
(1) Family history: It should be determined whether the parents are consanguineous, whether there are blind, deaf, epilepsy, cerebral palsy, congenital malformations, MR, and psychiatric patients in the family.
(2) Maternal pregnancy history: Inquire whether there was viral infection, miscarriage, bleeding, injury during early pregnancy, whether chemical drugs were taken, whether toxic substances were exposed, whether radiation was encountered, whether hypothyroidism, diabetes, or severe malnutrition were present, whether there were multiple births, polyhydramnios, placental insufficiency, or incompatibility of maternal and fetal blood types.
(3) Birth history: Whether it was premature or postterm birth, whether there were any abnormalities in delivery methods, whether the birth weight was low birth weight, whether there was asphyxia after birth, birth injuries, intracranial hemorrhage, severe jaundice, or congenital malformations.
(4) Growth and development history: Including the onset of neuropsychiatric symptoms, such as the time when major motor skills like lifting the head, sitting up, and walking began to appear, the completion of fine motor skills like picking up small toys and daily utensils with fingers, the development status of language functions like calling parents and understanding speech, as well as other intellectual and behavioral manifestations such as eating, dressing, and controlling bowel and bladder.
(5) Past and present medical history: Whether there was cranial head trauma, bleeding, central nervous system infection, severe systemic infection, or convulsive attacks.
2. Physical examination
3. Developmental examination
4. Neuropsychological examination
5. Laboratory tests Laboratory tests include biochemical tests of blood, urine, brain, and cerebrospinal fluid, cranial X-ray and CT examinations, cerebral angiography, electroencephalography, evoked potentials, hearing tests, chromosome analysis, pituitary, thyroid, gonadal, and adrenal function tests, as well as virus (such as cytomegalovirus, rubella virus), protozoa (such as toxoplasma), and antibody tests. Relevant items should be selected based on diagnostic needs.
6. Intelligence testing and behavioral assessment Mild MR is often diagnosed using intelligence tests, while intelligence testing methods are often difficult to use for moderate to severe MR and must rely on behavioral rating scales. However, rating scales are not as reliable as intelligence tests for differentiating mild MR. Therefore, both methods should be used in combination, and the results must be comprehensively analyzed.
Recommendations:
Intelligence testing methods
1. Screening methods When using general intelligence testing methods, it often takes a long time, sometimes 1 to 2 hours or more, which is not conducive to general pediatricians or child health screening. Therefore, some simple screening methods are used. The content of the test is mostly selected from various classic intelligence testing methods. The test only requires a short time and can preliminarily screen out suspected cases. Screening results can only serve as a basis for determining whether further examination is needed and cannot be used to make a diagnosis. Currently, the following screening methods are commonly used in China.
(1) Denver developmental screening test (DDST): Suitable for children from birth to 6 years old, with simple operation, short time consumption, simple tools, and good reliability and validity. This method has been widely adopted worldwide. China began using this method in the early 1980s. Cities like Shanghai and Beijing have standardized the DDST based on the characteristics of Chinese society, economy, language, culture, education methods, and geographical environment, and have developed the child intelligence development screening scale (DDST-R).
(2) Draw-a-person test: Scoring is based on the drawing of a human figure to judge the level of intellectual development. It is suitable for intelligence screening for children aged 5 to 12. Younger children tend to score higher, while older children tend to score lower. The draw-a-person test has a significant correlation with IQ obtained from other intelligence tests.
2. Diagnostic methods
(1) Wechsler Intelligence Scale for Children-CR (WISC-CR): Suitable for children aged 6 to 16.
(2) Chinese-Wechsler Preschool and Primary Scale of Intelligence (CWYCSI): Suitable for children aged 4 to 6 and a half.
(3) Gesell ScaleR for Infants and Young Children: Suitable for children aged 0 to 3.
Adaptive behavior assessment methods
1. Infant-Toddler Social Competence Scale: Suitable for children aged 6 months to 13 to 15 years. This scale is an essential tool for diagnosing MR and grading.
2. Neonatal Behavioral Neurological Assessment (NBNA) The national association has determined the normal range of NBNA for newborns through research, and its clinical application is gradually being carried out.
Life care: