Neuropsychological

Disabilities
Contents
• Mental retardation
• Cerebral palsy
• Minimal Brain Dysfunction
• Childhood Autism

Dr Kilasara
 Introduction
• In 1981 Disabled People’s International
stated that;
– Disability is the loss or limitation of
opportunities to take part in the normal life of
the community on an equal level with others
due to physical and social barriers.

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• Children with disability have additional needs
and require extra help to have enough
stimulation to achieve their potential and not
just to see their impairment.
• Impairment becomes disability only if the
environment is not adjusted to enable the
child to function effectively

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 Classification of children with
impairment
• Intellectual impairment e.g. mental retard.,
down syndrome, minimal brain damage,
autism, microcephaly
• Physical impairment e.g. cerebral palsy,
spinal bifida, muscular dystrophy
• Sensory impairment e.g blindness, deafness
• Medically compromised
• Combination of impairments
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 Mental Retardation
• Synonyms; mental handicap, mental
subnormality or mental deficiency.
• Mental retardation is a generalized
disorder, characterized by significantly
impaired cognitive functioning and deficits
in two or more adaptive behaviors with
onset before the age of 18

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 Characteristics
• Low general intelligence
• Failure of adaptation
• Early age of onset
• Slow in general mental development
• Difficulties in attention, perception, memory
and thinking

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• The limitations of cognitive functioning will
cause the child to learn and develop more
slowly than a typical child.
• may take longer to learn language,
develop social skills, and take care of their
personal needs such as dressing or
eating.

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• Learning will take longer, require more
repetition, and skills may need to be
adapted to their learning level.
• Nevertheless, virtually every child is able
to learn, develop and become participating
members of the community

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 Causes
Common causes are:
• Genetic conditions e.g. down syndrome,
fragile X sndrome
• Problems during pregnancy e.g. fetal
alcohol syndrome, infection like rubella
• Problems at birth i.e. birth anoxia

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• Certain diseases e.g. whooping cough,
measles
• Exposure to toxins like lead or mercury
• Iodine deficiency
• Malnutrition

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 Oral health
• Dental caries: often more untreated decay,
more missing and fewer filled teeth
• Perio diseases: compromised periodontal
status due to their inability to comprehend
and thus comply with oral hygiene
measures like tooth brushing.
• Malocclusion: orthodontic anomaly is
higher b/se many are untreated
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 Operative Procedures
• may accept dental treatment and react
positively to warm and friendly atmosphere
• ability to accept specific procedures such
as local anesthetic and high speed
instruments will depend on their degree of
understanding and age.

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• Isolation is difficult due to poor control of
movements.
• Start new procedures slowly and
communicate directly to the child.
• If this does not work then general
anesthesia may be of help in these
children.

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 Cerebral Palsy
• Cerebral palsy describes a group of
permanent disorders of the development
of movement and posture, causing activity
limitation, that are attributed to non-
progressive disturbances that occurred in
the developing fetal or infant brain.

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• In industrialized world cerebral palsy
occurs in 2 children per 1000 live births.
• The incidence is higher in male than
female

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 Classification
• Is classified according to motor defect; can
be pre-, peri-, or post-natal origin
– Spasticity – impaired ability to control
voluntary movements; occurs in 50% of cases
of cerebral palsy
– Athetosis – uncontrolled, slow twisting and
writhing movements which are frequent and
involuntary and occurs in over 16% of cases

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– Rigidity – resistance to passive movements
which may be overcome by sudden action
– Ataxia – disturbances of equilibrium as well as
difficult in grasping objects
– Hypotonia – all muscles are flaccid with
decreased muscle tone
– Mixed – combination of above

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 Early signs
• Delayed milestones such as controlling head,
rolling over, reaching with one hand, sitting
without support, crawling, or walking
• Persistence of “infantile” or “primitive” reflexes,
which normally disappear 3-6 months after birth
• Developing handedness before age 18 months:
This indicates weakness or abnormal muscle
tone on one side, which may be an early sign of
CP.

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 Dental features
• Increased periodontitis
• Drug induced gingival overgrowth
• Malocclusion (increased prevalence of
skeletal class II with anterior open bite)
• Tendency to bruxism
• Tongue thrust and mouth breathing

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• Increased in caries prevalence and
anterior trauma
• Enamel hypoplasia
• Increased gag reflex and perioral
sensitivity
• Poor oral hygiene
• Drooling
• Decreased parotid flow
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 Operative procedures
• Eager to cooperate but lack of muscular
control frustrates them
• Altered gag and cough reflexes may
complicate the delivery of dental care or
provision of prosthesis
• Reassurance, good aspiration and skilled
assistance may be of great help

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• Long procedures in dental chair without
break are best avoided
• Hypoplastic teeth may be very sensitive to
cold and may cause discomfort during
tooth preparation
• Use of desensitizing agents like duraphat
fluoride
• Nitrous oxide sedation may help
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 Childhood Autism
• Is chronic and lifelong pervasive
developmental disorder defined by the
presence of abnormal and/or impaired
development that is manifest before the
age of 3 years, & by the characteristic type
of abnormal functioning in all three areas
– social interaction,
– communication, and
– restricted, repetitive behavior.

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• The disorder occurs in boys three to four
times more often than in girls with
prevalence of 0.03 to 0.1%

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 Dental procedures
• Underlines the particular importance of
acclimatization and familiarity of routines
therefore;
– Plan dental care on long term basis in close
cooperation with parents and teachers-start
early e.g. tooth brushing
– Frequent visits to the same dental office

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– Minimal change of personnel
– Record phobias e.g. cotton rolls, strong
smells and record favourite activities e.g.
music or touching special fabrics
– Sedation has little effect
– Avoid general anesthesia

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 Minimal Brain Dysfunction
• This category of disability is used to
describe the child who has minor
neurological signs, which are often
transitory
• They are not reliable predictors of future
behavioral and educational problems

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 Dental procedures
• Concentration is a problem
• Cooperation in a dental chair is major
problem
• Use few words, short sessions and eye
contact when instructing
• Nitrous oxide sedation may be of help

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 References
– Lawrence Miall, Mary Rudolf, Malcolm Levene:
Paedriatics at Glance. First edition 2002.
– Christine Hobert, Jill Frankel: Childminding; A Guide
to Good Practice. Second edition 2003
– Judith Collier, Murray Longmore, Mark Brinsden:
Oxford Handbook of Clinical Specialities. Seventh
edition 2006
– Kumar and Clark’s: Clinical Medicine. Seventh edition
2007
– Richard R. Welbury: Paediatric Dentistry. Second
edition 2001
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