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 Table of Contents  
ORIGINAL ARTICLE
Year : 2012  |  Volume : 1  |  Issue : 2  |  Page : 61-66

Physical growth during adolescence in mentally retarded children


1 Assistant Professor of Anatomy, GS Medical College & Hospital, Ramnagar, Patiala, Punjab, India
2 Professor of Anatomy, CMC, Ludhiana, Punjab, India
3 Professor of Pediatrics, CMC, Ludhiana, Punjab, India
4 Professor of Psychiatry, CMC, Ludhiana, Punjab, India

Date of Web Publication23-Jan-2020

Correspondence Address:
Sukhinder Baidwan
House No 313, Sector 71, Mohali, SAS Nagar, Punjab -160 071
India
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Source of Support: None, Conflict of Interest: None


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  Abstract 


Background and aims: Growth in children with mental retardation differs from that of normal children, but majority of studies have been performed in western countries and have focused on the early years of life. The purpose of this study therefore was to evaluate the growth pattern of male mentally retarded adolescents from North India and compare it with that of normal male children. Materials and methods: Two hundred institutionalized intellectually disabled (I.Q. less than 70) and two hundred normal male children between 1020 years of age from North India were selected and the physical growth parameters i.e. height and weight were measured and Body Mass Index (BMI) was calculated in all subjects. The mentally retarded and normal groups of boys were categorized separately on the basis of their age into one-year age groups. The data was then compared between the two groups using 2 sample’t’ test. Results: The results indicated that the mean height and weight of mentally retarded boys during adolescence was significantly retarded as compared to normal subjects. However, the intellectually disabled and the normal group do not show any significant difference in their body fat during adolescence. The mean height and weight gain of mentally retarded children during adolescence (11-20 years) however did not vary from that of normal children. Conclusions: Thus, the physical growth retardation in children with intellectual disabilities occurs during early childhood i.e. before 11 years of age.

Keywords: Adolescence, Growth, Mental retardation


How to cite this article:
Baidwan S, Paul MM, Chhatwal J, Deswal R S. Physical growth during adolescence in mentally retarded children. Natl J Clin Anat 2012;1:61-6

How to cite this URL:
Baidwan S, Paul MM, Chhatwal J, Deswal R S. Physical growth during adolescence in mentally retarded children. Natl J Clin Anat [serial online] 2012 [cited 2021 Jan 17];1:61-6. Available from: http://www.njca.info/text.asp?2012/1/2/61/298008




  Introduction Top


Mental Retardation constitutes a clinically and socially relevant condition accounting for 3% of the pediatric population. Very little is known about the physical growth and development of the mentally retarded children[1].

Children with mental retardation are by definition characterized by significantly sub average general intellectual functioning resulting in or associated with concurrent impairments in adaptive behaviours. However, it is unclear whether they grow at the same rate physically as do children without mental retardation because the results of the studies within this area have been contradictory[2].

The parents and caregivers of mentally retarded children often raise concerns about the growth of their wards during puberty. There is therefore a need to examine and evaluate the growth rate and timing of adolescent growth spurt in these children. Several studies conducted in the western world have however highlighted the differential growth patterns among mentally retarded and normal healthy children of same age group and belonging to similar socio-economic status[3],[4].

The purpose of this study, therefore, was to evaluate the growth of adolescent mentally retarded children in North Indian population and to compare it with that of normal children of same age group. This would help the clinicians and parents in monitoring and predicting the growth of their adolescent mentally retarded children.


  Materials and Methods Top


The study was carried out on a total of four hundred children between 10-20 years of age, after obtaining permission from the institutional ethical committee. The exact age of the subjects was verified from birth certificates and school records.

Selection of Sample: All the schools for mentally retarded children in two cities of Punjab (Ludhiana and Patiala), Union Territory of Chandigarh and one city of Haryana (Panchkula) were selected. A total of six schools were included and all male students present on the day of the visit were selected for the study. Intelligence Quotient (IQ) for mentally retarded children was assessed by a clinical psychologist using age standardized cognitive ability tests like Wechsler Intelligence Scale for Children (WISC), Standard Binet Intelligence scale (SBIS) or Intelligence Scale for Indian Children by Malin (ISIC)[5]. Children having an IQ below 70 were selected as the mentally retarded group. The normal group consisted of 200 normal adolescent male children studying in schools and colleges in North India.

Criteria for Exclusion: Children with gross morphological defect like absence of limb or severe orthopedic malformation or suffering from any chronic illnesses were excluded from the study. All subjects belonging to low socio-economic status based on Prasad’s classification of 1970 per capita income were excluded[6].

Recording of Anthropometric Measurements : The height and weight were recorded for each subject using standard equipments and standard techniques[7]. Standard standing height was taken with a calibrated vertical rod with a movable horizontal headboard placed on hard even floor. The subject was asked to remove his shoes and then stand on the horizontal platform with heels together, arms hanging freely by the sides and the back of the head, buttocks and heels touching the vertical rod. The head was held comfortably erect with the lower border of the orbit in the same horizontal plane as the upper margin of the external auditory meatus i.e. Frankfurt’s plane. The horizontal headboard was then gently lowered, crushing the hair and making contact with the top of the head. The reading was taken to the nearest 0.1cm. The weight was recorded with a standardized electronic weighing scale. Each subject was weighed with light clothing and without shoes, and was asked to stand still on the weighing machine with the weight evenly distributed between the two feet. Body Mass Index was calculated using the Quetelet formula and expressed in unit of measure as Kg/m2:



Statistical analysis

The mentally retarded (MR) and normal (N) group of boys were categorized on the basis of their age into one-year age groups.

The mean value and the standard deviation were calculated for each anthropometric parameter for each age group.

The data for MR and N were statistically compared using 2- sample’t’ test.


  Results Top


A total of400 male children in the age group between 11-20 years belonging to high socio-economic status from North India were enrolled for the study. Two hundred children with intellectual disabilities (I.Q. less than 70) from schools for special children and 200 normal children from regular schools between 10-20 years of age from North India were categorized on the basis of their age into one-year age groups.

Height: A comparison of the mean height and standard deviations of mentally retarded and normal males shows that the mentally retarded boys were significantly shorter than the normal group at all ages except 13 and 14 years of age, where they apparently were shorter but not statistically significant. The maximum height spurt in mentally retarded boys was earlier i.e. at 12-13 years as compared to the normal group where it was at 14-15 years of age. Whereas the mean height gain during 11-20 years in mentally retarded boys (29.81cm) was slightly more than the normal group (28.49cm), the difference was statistically insignificant [Table 1] & [Chart 1].
Table 1: Comparison of mean height of mentally retarded and normal males

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Weight

The mentally retarded boys were lighter than the normal boys at all age groups as shown in [Table 2] and the difference was statistically significant in the age group of 15-17 years. The mean weight gain during 1120 years of age for mentally retarded boys was 23.76kg as compared to 25.20kg for normal group, the difference being insignificant.
Table 2: Comparison of mean weight of mentally retarded and normal males

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Body mass index

A comparison of the mean BMI values of mentally retarded and normal group in boys is shown in [Table 3]. The values for the mentally retarded and normal groups were similar and the mean BMI was gradually increasing with age.
Table 3: Comparison of mean body mass index of mentally retarded and normal males

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  Discussion Top


In the present study the mentally retarded boys were consistently shorter than the normal group at all ages. The height curve of mentally retarded boys in the present study was about one standard deviation below the normal boys. This is in accordance with various studies which have reported that the mentally retarded boys are short statured when compared with normal standards[8],[9].

The age of adolescent height spurt i.e. the age of maximum increase in mean height for mentally retarded males in the present study is 12.5 years which is comparable with similar findings in Japanese[10] and Hungarian[11] mentally retarded boys. The boys with mental retardation experienced their maximum mean height increment one year earlier than the normal boys as noted in a previous study[12].



While the retardation in height was present at all ages during adolescence i.e. from 11-20 years, it was evident that the mean increase in height during this period was similar for mentally retarded and normal boys. This indicates that the height retardation in mentally retarded subjects occurred prior to 11 years of age and is consistent with the earlier findings[13],[14].

The mentally retarded boys weigh lesser than the normal at all ages during adolescence, which confirms the findings of previous studies in America[14],[15]. In this study both mentally retarded and normal groups expressed a great variability in their weights during adolescence, expressed by increased values of standard deviation in all groups. This is probably due to adolescent growth spurts occurring at different time and different rates and is in accordance with similar findings in a study on mentally retarded children in Philadelphia[15].

The mean weight gain was similar for mentally retarded and normal subjects during adolescence. This finding is supported by previous results[14],[15],[16].

The study shows a gradual increase in the Body Mass Index with age in both mentally retarded as well as normal population, also seen in a similar study[17]. Body Mass Index for age is recommended as a good anthropometric indicator of thinness and obesity during adolescence, thus the mentally retarded population and the normal boys do not show any significant difference in their body fat during adolescence in this study. Numerous studies have documented the increased prevalence of obesity amongst the mentally retarded population [18],[19],[20]. These results are however centered on adults (>20years) and therefore cannot be compared with the present study. Previous studies have shown that upto 20 years of age the body mass index of both groups do not show a significant difference[16],[17]. The adult mentally retarded falling in age group of 21-45 years show increased body fat when compared with the normal group.

The mentally retarded subjects in this study were institutionalized in special schools and based on input that was received from their administrators it was discovered that their diet is monitored and they have greater access to recreational physical activities and games. Therefore, a combination of increased activity level and adequate intake of diet may contribute to insignificant difference in body fat amongst the mentally retarded and normal group. Previous studies have also highlighted that mentally retarded population living in institutions have less BMI values compared to those living in home settings[4],[21].


  Conclusions Top


The findings from this survey show that the physical growth of mentally retarded boys during adolescence (11-20 years) was retarded as compared to the normal children. However, the mean incremental gain in height and weight over this same 10 year period was almost identical for the mentally retarded and normal populations. Thus, it is apparent that the factors leading to the growth retardation of the mentally retarded group must have come into play in early childhood, prior to eleven years of age. The body mass index for institutionalized mentally retarded adolescent boys is same as the normal boys.



 
  References Top

1.
Sanchez-Lastres J, Eiris-Punal J, Otero-Cepeda J, Pavon-Belinchon P & Castro-Gago M. The impact of sociofamilial factors on nutritional status in intellectually disabled children. Rev Neurol. 2002; 34(11): 1001-9.  Back to cited text no. 1
    
2.
Lindgren GW, Katoda H. Maturational rate of Tokyo Children with and without mental retardation. Am J Ment Retard. 1993; 98(1): 128-134.  Back to cited text no. 2
    
3.
Sanchez-Lastres J, Eiris-Punal J, Otero-Cepeda J, Pavon-Belinchon P & Castro-Gago M. Nutritional status of intellectually disabled children in north-west Spain. I. Anthropometric indicators. Acta Paediatr. 2003; 92: 747-753.  Back to cited text no. 3
    
4.
Velez TC, Fitzpatrick AL, Barbosa CI, Diaz M, Urzua M & Andrade HA. Nutritional status and obesity in children and young adults with disabilities in Punta Arenas, Patagonia, Chile. Int J Rehabil Res. 2008; 31(4): 305-313.  Back to cited text no. 4
    
5.
Kesaree N, Kolli S. IAP Textbook of Pediatrics. 3rd ed. Jaypee Brothers. New Delhi, 2006: 333-336.  Back to cited text no. 5
    
6.
Prasad BG. Changes proposed in Social classification of Indian Families. J Indian Med Assoc. 1970; 55:1989.  Back to cited text no. 6
    
7.
Frisancho AR. Anthropometric standards for the assessment of growth and nutritional status. Ann Arbor; The University of Michigan press. USA, 1990 : 8-12.  Back to cited text no. 7
    
8.
Lavriashin BV, Chikishera TA. Features of the growth and physical development of mentally retarded school age children. Zh Nevropatol Psikhiatr. 1985; 85(3): 398-404.  Back to cited text no. 8
    
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Yokoyama Y. Relationship between physique and measured intelligence level in mentally retarded children. Shinrigaku Kenkyu. 1985; 55(6): 370-373.  Back to cited text no. 9
    
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Hirasawa H. Longitudinal study on physical growth in mentally retarded children. Journal of Subjects Study. 1984; 20: 341-354.  Back to cited text no. 10
    
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Buday J and Kaposi J. Body development of mentally retarded-a mixed longitudinal study. Anthropologiai Kozlemenyek. 1986; 30: 97-105.  Back to cited text no. 11
    
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Kimura J, Tachibana K, Imaizumi K, Kurosawa K & Kuroki Y. Longitudinal growth and height velocity of Japanese children with Down’s syndrome. Acta Paediatr. 2003; 92: 1039-1042.  Back to cited text no. 12
    
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Dutton G. The physical development of Mongols. Arch Dis Child. 1959; 34: 46.  Back to cited text no. 13
    
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Rarick GL, Seefeldt V. Observations from longitudinal data on growth in stature and sitting height of children with Down’s Syndrome. J Ment Defic Res. 1974; 18: 63-78.  Back to cited text no. 14
    
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Bailit HL, Whelan MA. Some factors related to size and intelligence in an institutionalized mentally retarded population. J Pediatr. 1967; 71(6): 897-909.  Back to cited text no. 15
    
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Rubin SS, Rimmer JH, Chicoine B, Braddock D, McGuire DE. Overweight prevalence in persons with Down’s syndrome. Ment Retard. 1998; 36(3): 175-181.  Back to cited text no. 16
    
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Melville CA, Cooper SA, McGrother CW, Thorp CF, Collacott R. Obesity in adults with Down Syndrome. J Intellect Disabil Res. 2005; 49(2): 125-133.  Back to cited text no. 17
    
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Fox R, Rotatori AF. Prevalence of obesity among mentally retarded adults. Am J Ment Defic. 1982; 87(2): 228-230.  Back to cited text no. 18
    
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Burkart JE, Fox RA, Rotatori AF. Obesity of Mentally Retarded Individuals: Prevalence, Characteristics and Intervention. Am J Ment Defic. 1985; 90(3): 303-312.  Back to cited text no. 19
    
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Hove O. Weight survey on adult persons with mental retardation living in the community. Res Dev Disabil. 2004; 25(1): 9-17.  Back to cited text no. 20
    
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Bronberg RA, Alfaro EL, Bejarano IF & Dipierri JE. Prevalence of malnutrition in institutionalized intellectually disabled patients. Medicina. 2011; 71(1): 1-8.  Back to cited text no. 21
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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