Moderate Mental Retardation Research Articles

Clinical Profile and Molecular Genetic Analysis of Prader - Willi Syndrome: A Single Center Experience.

Aim:The prevalence of childhood and adolescent obesity is increasing worldwide as well as in India. Prader–-Willi syndrome (PWS) is one of the most common causes of syndromic obesity with varied clinical manifestations across different lifespan. Herewith, we describe clinical and molecular characteristics of eight PWS who were diagnosed in an obesity clinic of tertiary care hospital.Materials and Methods:Clinically suspected cases of PWS were screened between January 2014 and January 2022. Detailed history and clinical examination were done to look for typical features of PWS like characteristic facial appearance, short stature, obesity, hyperphagia, delayed puberty or hypogonadism, diabetes mellitus, developmental delay, cognitive dysfunction, learning disabilities or abnormal behavior. All were evaluated, with 75 g oral glucose tolerance tests (GTT), HbA1c, Free T4, TSH, LH, FSH, testosterone, and growth hormone level. Intelligent quotient (IQ) of each patient was assessed by a psychiatrist using Binet–Kamat test. Molecular confirmation of clinically suspected PWS was done by either Methylation-specific polymerase chain reaction (MS-PCR) or Fluorescence in situ Hybridization (FISH) methods.Results:Based on clinical and molecular characteristics, eight were diagnosed as PWS. Except one, all were male with characteristic facies, mean age of study cohort was 12 years and mean BMI of 44.58. Obesity, short stature, hyperphagia, hypotonia, and mild to moderate mental retardation were noted in entire (100%) PWS study population. All male PWS patients had cryptorchidism, which was bilateral in six patients and unilateral (right undescended testes) in one. Apart from obesity, short stature, other endocrine associations noted were diabetes mellitus in 50% and subclinical hypothyroidism in 37% of PWS. Molecular characteristics of PWS were confirmed by Methylation-specific PCR in seven and by FISH method in one.Conclusion:Prader–Willi syndrome should be kept in mind in case of childhood or adolescent obesity with short stature, hypotonia, cryptorchidism, and developmental delay or cognitive dysfunction. Judicious use of molecular diagnostic testing should be made in all clinically suspected cases. Early diagnosis and appropriate management of this complex disorder by a multidisciplinary team will improve the quality of life and treatment outcome.

Formation of Communication Skills in Junior Schoolchildren with Intellectual Disabilities in the Conditions of Inclusive Education

The article deals with pedagogical and psycho-correctional means of ensuring communicative interaction of junior schoolchildren with disabilities (with mild and moderate mental retardation) in the context of inclusive education. Specifics of development of cognitive, emotional, personal-motivational, communicative and behavioural components of communication of a unique personality of a junior schoolchild under correctional and developmental influence and in the conditions of inclusive education are analysed. The definition of communication skills of children with special educational needs has been clarified. Systematic - neuropedagogical, competence, personality-oriented and communicative-activity approaches to consideration of methodical tools for formation of communicative skills in junior schoolchildren taking into account their special needs and individual capabilities are applied. A model of formation of communicative-personal potential in children with intellectual disabilities and correction of their communicative individual-psychological properties has been developed. The program on formation of communicative competence and providing positive motivation for communicative interaction among students with intellectual disabilities, taking into account neuropsychological and pedagogical recommendations, is substantiated.

Implications of Down's syndrome on oral health status in patients: A prevalence-based study.

Background:Down syndrome which is also known as “trisomy 21” is the commonest chromosomal defect that has been associated with intellectual disability or impairment. Clinically, it has been characterized by the generalized presence of hypotonic musculature, variety of neurobiological alterations, numerous respiratory diseases, and significantly higher risk of developing infection along with various dental abnormalities and oro-facial dysmorphological changes. Periodontal diseases are the most prominent oral health issue among individuals diagnosed with Down Syndrome.Aim:The objective of the present prevalence analysis was to study the implications of Down’s syndrome on oral health status among patients.Materials and Methods:This was a descriptive and cross-sectional prevalence analysis conducted within a duration of 1 year. A total of 100 children diagnosed with Down syndrome (aged between 5 and 16 years) were selected as the study sample. Inclusion criteria were (a) cytogenetic positive trisomy 21, (b) cooperative behavior, and (c) written informed consent obtained from the legal care-takers. Exclusion criteria were (a) any debilitating form of systemic diseases, (b) any other disability, and (c) extremely uncooperative children. The gingival health status was assessed using gingival index (GI) [Loe and Silness], calculus index (CI) [Ramfjord], and plaque index (PI) [Silness and Loe]. Information involving the practice of oral hygiene maintenance, diet plans, and parental educational status was derived from each parent. Based upon their intelligence quotient (I. Q.) values, the subjects were classified into three groups: a) mild (I. Q. level = 50 to 70), b) moderate (I. Q. level = 35 to 50), and c) severe (I. Q. level ≤35). Statistical analysis was performed using the statistical software tool Statistical Package for Social Sciences (SPSS) version 20.0. Qualitative data were recorded as frequencies, and percentages and quantitative data were recorded as mean and standard deviation values. All categorical outcomes were analyzed by means of the Chi-square test. The quantitative outcomes of Calculus Index, Gingival Index, and Plaque Index were analyzed by either student’s t-test or one-way analysis of variance (ANOVA). Significance was set at a cut-off value of P < 0.05.Results:Down syndromic children between 12 and 16 years were reported to have statistically significant higher Calculus Index, Gingival Index, and Plaque Index values in comparison with younger age syndromic children (P < 0.01). Those with severe mental retardation had significantly higher Plaque Index (P < 0.001) and Gingival Index (P < 0.04) values when compared with those with mild and moderate mental retardation. No significant difference in comparing Calculus Index was noted.Conclusion:Higher age group children with Down syndrome require close monitoring by parents for assisting in maintaining oral hygiene practices just as in younger age group children.

UPAYA MENINGKATKAN KEMAMPUAN OKUPASI ANAK TUNAGRAHITA SEDANG MELALUI PELAKSANAAN PROGRAM TERPADU BHAKTI LUHUR

Children with moderate mental retardation are a category of children who need assistance in learning everything including in the field of household work occupations. The Bhakti Luhur Integrated Program (PTBL) is a flagship program used by the Bhakti Luhur Foundation that is involved in handling people with disabilities, one of which is mentally retarded children. One of the fields in the Integrated Bhakti Luhur Program (PTBL) is the occupational field with the sub-sector of household work. This study aims to assess whether household work occupational training is effective in improving the ability of children with moderate mental retardation. This study uses a quantitative descriptive research design, with the subject of 4 children with moderate mental retardation. The data collection method used is full participant observation. Meanwhile, data analysis was carried out by processing the final test minus the initial test and then presenting it. The results showed that: for the PU subject from the four exercise items, the results were 50.8%, for the PA subject from the four exercise items the results were 56%, for the AG subject from the four exercise items the results were 65%, for the MZ subject from the four exercise items the results were obtained. 82.5%.

Treatment of a patient with COVID-19 and adverse premorbid background: A case report

BACKGROUND: In the presence of severe comorbid pathology, children get sick with coronavirus disease 2019 (COVID-19) as severe as adults.&#x0D; CASE REPORT: This paper describes the treatment of a 17-year-old patient with severe bilateral pneumonia caused by severe acute respiratory syndrome coronavirus 2 that damage a large volume of the lung tissue (69% on the right, 87.1% on the left, and grade IV lung lesions according to computed tomography) with an unfavorable premorbid background (grade IV obesity with a body mass index of 54.5 kg/m2, Down syndrome, moderate mental retardation, and primary hypothyroidism). The child was admitted to the hospital on day 10 of illness in an extremely serious condition. On admission, she received artificial lung ventilation and then high-flow mask ventilation with an oxygen flow of 12 L/min. In addition to respiratory support, she received etiotropic (hydroxychloroquine), anticoagulant (enoxaparin), antibacterial, (ceftriaxone), and antihypertensive treatments. Levothyroxine sodium was administered for hypothyroidism. Permanent monitoring of the acidbase balance, general and biochemical blood tests, and coagulography were performed. Gradual positive dynamics of the respiratory status was observed, and oxygen flow decreased. The case was constantly consulted to a pulmonologist, endocrinologist, and cardiologist, who corrected antihypertensive therapy depending on blood pressure indicators. Oxygen support was given for 13 days. After receiving a double-negative PCR test for COVID-19, the patient was transferred to the pulmonology department, from which she was discharged in satisfactory condition for outpatient observation.&#x0D; CONCLUSION: Our patient with COVID-19, severe lung damage with a combination of comorbid pathologies, extremely unfavorable prognosis (grade IV obesity, Down syndrome, and hypothyroidism), who received active complex treatment in accordance with modern guidelines, recovered despite late admission to the hospital.

Prenatal genetic testing in 19 fetuses with corpus callosum abnormality.

BackgroundCorpus callosum abnormality (CCA) can lead to epilepsy, moderate severe neurologic or mental retardation. The prognosis of CCA is closely related to genetic etiology. However, copy number variations (CNVs) associated with fetal CCA are still limited and need to be further identified. Only a few scattered cases have been reported to diagnose CCA by whole exome sequencing (WES).MethodsKaryotyping analysis, copy number variation sequencing (CNV‐seq), chromosomal microarray analysis (CMA) and WES were parallelly performed for prenatal diagnosis of 19 CCA cases.ResultsThe total detection rate of karyotyping analysis, CMA (or CNV‐seq) and WES were 15.79% (3/19), 21.05% (4/19) and 40.00% (2/5), respectively. Two cases (case 11 and case 15) were diagnosed as aneuploidy (47, XY, + 13 and 47, XX, + 21) by karyotyping analysis and CNV‐seq. Karyotyping analysis revealed an unknown origin fragment (46,XY,add(13)(p11.2)) in case 3, which was further confirmed to originate from p13.3p11.2 of chromosome 17 by CNV‐seq. CMA revealed arr1q43q44 (238923617–246964774) × 1(8.04 Mb) in case 8 with a negative result of chromosome karyotype. WES revealed that 2 of 5 cases with negative results of karyotyping and CNV‐seq or CMA carried pathogenic genes ALDH7A1 and ARID1B.ConclusionParallel genetic tests showed that CNV‐seq and CMA are able to identify additional, clinically significant cytogenetic information of CCA compared to karyotyping; WES significantly improves the detection rate of genetic etiology of CCA. For the patients with a negative results of CNV‐seq or CMA, further WES test is recommended.

Clinico-Metabolic Profile of Neurometabolic Disorders of Children in a Tertiary Care Hospital of Bangladesh

Background: Neurometabolic disorders are inborn errors of metabolism with neurological manifestations. They are individually rare but as a group have a significant burden. They constitute 4.9% of genetic cause of moderate and severe mental retardation.&#x0D; Aims and objective: To explore clinical &amp; metabolic profile of various forms of childhood Neurometabolic disorders.&#x0D; Methods: A hospital based retrospective study was conducted at Department of Pediatric Neurology, Bangabandhu Sheikh Mujib Medical University, and Dhaka from January 2016 to December 2020. Total 59 suspected children of Neurometabolic disorders (NMD), who admitted in hospital during the study period, were included. Among them 41 cases of NMD were diagnoses confirmed on the basis of clinical suspicion, biochemical test, and neuroimaging study and in few cases molecular genetics investigations.&#x0D; Results: Among 59 suspected cases, total 41 patients were diagnosed as Neurometabolic disorders. Most of the (63.2%) patients were within 0-3 years age. Male patients (70.73%) were outnumbered than female (29.26%). Male: Female ratio were 2.4:1. More than half of patients 25(60.90%) had parental consanguinity followed by Sib death 7 (17.07%), Prematurity 11 (26.82%). Common Neurometabolic disorders were aminoacidopathy 14 (34.14%) and lysosomal storage disorders 15 (36.58%) followed by mitochondrial disorders 5(12.19%), Urea cycle disorders 3(7.31%), CHO metabolism disorders 5(2.43%), Peroxisomal disorders 3(7.31%). Among aminoacidopathy, Organic acidamia 4(9.72%), MSUD 3(7.31%), PKU 2(4.86%), Gluteric Aciduria 3(7.31%), and Biotinidase deficiency disorder 1(2.43%) were common disorders. Among lysosomal storage disorders, mucopolysaccaridosis 4(9.72%) and metachromatic leukodystrophy 8(19.44%) were most common disorders. Common presentations were developmental delay 37(90.24%), developmental regression 21(51.21%), hypotonia 29(70.73) and seizures 26(63.41%). Neuroimaging changes found in about three fourth (80.49%) of cases. About 26.82% cases presented with white matter hyper intensity followed by basal ganglia hyper intensity (19.51%) and cerebral atrophy (14.63%). Abnormally high ammonia and lactate found in 6(14.63%) and 10(24.40%) cases respectively followed by Positive urinary ketones 8 (19.51%).&#x0D; Conclusions: Neurometabolic disorders are not uncommon. The commonest neurometabolic disorders were aminoaciduria and lysosomal storage disease in our study. Among aminoacid disorders, Organic acidamia, MSUD, Glutaric aciduria and in lysosomal storage disorders metachromatic leukodystrophy &amp; Mucopolysaccharoidosis were common disorders. Neuroimaging changes were found in about three- forth cases in this study.

CASE STUDY OF MEDIUM LEVELS OF CHILDREN OF MIDDLE LEVELS OF SMPKH YDKW 01 TANGERANG CLASS VII ACADEMIC YEAR 2020/2021 IN ADMINISTRATION AND REDUCTION OPERATIONS WITH BRUNER THEORY

Without us realizing that mathematics is not spared in our daily lives, without mathematics everyone will find it difficult to live life. This study aims to find out how to add and subtract moderately mentally retarded children based on symbols. The type of research carried out by the researcher is qualitative with the case study method, so that the research subjects are 4 mentally retarded children who are in class VII SMPK YDKW 01 Tangerang. The results of the study are in the form of a description that describes how to add and subtract operations with symbols in Bruner's theory, from the results of research in the field, children with moderate mental retardation do not meet the minimum completeness criteria, only 25% are able to meet the minimum completeness criteria.

THE EFFECTIVENESS OF INCIDENTAL TEACHING WITH DISTANCE FAMILY EDUCATION ON MAND (REQUEST REPORTING) TRAINING

In the study, the effect of incidental teaching method on teaching students with moderate mental retardations the ability to report requests through distance family education was examined. The study was conducted with a 10-year-old male student with moderate mental retardation and bilateral mild hearing loss. The aim of the study is to contribute to the student's expressive language skills, which is one of the expressive language skills, by teaching 20 determined words. ABAB model, one of the single-subject research models, was used in the study. According to the findings of the study, the incidental teaching method, is given with distance family education, contributed to the student's gaining the ability to express requests. As a result of the study, it was seen that the incidental teaching method applied with distance family education was effective in gaining the ability to express requests.

Anaesthetic Management of a Child with Congenital Rubella Syndrome Posted for Cochlear Implant - A Case Report

Congenital Rubella Syndrome (CRS) is a constellation of multi-system abnormalities and each problem has significant anaesthetic implications. These patients pose various challenge to anesthesiologists like unanticipated difficult airway, uncorrected cardiac lesions, etc. Anesthetic for cochlear implant in child with CRS has not been reported. Anaesthetic management in an infant with PS should be based on decrease in pulmonary vascular resistance (PVR), avoidance of tachycardia with sinus rhythm, myocardial depression, systemic hypotension and adequate intra vascular volume. Here we report the anaesthetic management of a 5 year aged child with congenital rubella syndrome - post device closure of Patent ductus arteriosus, bilateral cataract surgery with moderate branch pulmonary artery stenosis and mental retardation posted for cochlear implant. Keywords: Congenital rubella syndrome, pulmonary artery stenosis, difficult airway, cochlear implant, patent ductus arteriosus.

Atypical Diabetes Mellitus Associated With Kabuki Syndrome: A Model of Epigenetic Disturbance in Insulin Resistance?

Background: Kabuki syndrome (KS) is a genetically heterogeneous disorder characterized by striking facial features similar to make-up of actors in Japanese Kabuki performance together with multi-organ defects. The first identified and most frequently involved gene is KMT2D which encodes a histone H3K4 methyltransferase. Even though KS is a rare syndrome and associated diabetes has been rarely reported, both type 1 DM and type 2 DM had been previously reported. Understanding the function of the genes that lead to KS opens up the possibility of targeted therapies for diabetes. Clinical Case: A 27-year-old male with unconfirmed diagnosis of Fragile X syndrome since childhood came to attend our diabetes clinic due to uncontrolled hyperglycemia (A1C 8.5%). He was a preterm baby born at 7 months and had been clinically diagnosed with Fragile X syndrome due to delayed development and moderate mental retardation from another hospital. At the age of 11 months, he underwent right nephrectomy from severe hydronephrosis. He later developed hypertension due to coarctation of aorta at the age of 14. At the age of 19, he presented with polyuria and lost 10 kilograms within 6 months (baseline BMI at 26.3 kg/m2). Laboratory data showed A1C 14.7%, plasma glucose 432 mg/dL, no ketonemia. At that time, youth-onset type 2 DM had been diagnosed and insulin treatment had been given for a few months before switching to oral medications. He presented at our hospital at the age of 27. Based on his facial features and multi-organ involvements, KS was clinically suspected and then was confirmed to have heterozygous frameshift deletion mutation (c.7524 deletion) of the KMT2D gene. Evaluation of beta-cell function revealed preserved beta-cell with stimulated C-peptide at 8.7 ng/mL. HOMA-IR score suggested severe insulin resistance (HOMA-IR 5.5). Pancreatic auto-antibodies revealed negative results. Currently, his diabetes has been fairly controlled (A1C varied from 6.8–8.5%). Conclusions: Our case highlights the importance of clinical recognizable phenotype in patients with diabetes. To study and decipher mechanistic studies of the role of epigenetic regulations in this syndrome toward insulin signaling pathways would provide an opportunity for novel insights into pathogenesis of epigenetic defects in Kabuki syndrome.

Effect of Bocce Game on Perceptual Motor Ability and Object Control among Adolescents with Mental Retardation

The study investigated the effect of the Bocce game on developing perceptual-motor ability and object control of adolescents with mental retardation. The subjects of the research were 15 adolescents with moderate Mental Retardation status (Age =16.4±1.59; IQ 54±.5). The study used a quasi-experimental method with a one-group pre-test post-test design. The analysis was conducted by using a T-test. The instrument used in this study was an observation employing an observation checklist adapted from Gallahue’s (1982) assessment checklist to measure perceptual-motor ability. A test was also employed to measure object control, including an underhand roll ball (grounder) test on the target using a Bocce ball with a 4-meter distance. The intervention of Bocce Game was given for 12 sessions. Each session lasted for 2 hours, 3 days per week. The statistical analysis showed the significant effect of the Bocce game on developing perceptual-motor ability (2.73 2.145) and object control (22.85 2.145). For that reason, it concludes that there is a significant effect of the Bocce game on perceptual-motor ability and object control of adolescents with mental retardation.

LEVEL OF INDEPENDENT LIVING SKILLS OF DAY SCHOLAR MODERATE MENTALLY RETARDED CHILDREN

Introduction Mental-retardation run with life, it is untreatable. But it can person having such situation can be trained by various methods. Mental-retardation cannot be said as mental disease. Mental-retardation is a situation where mental age is not matching with chronological age. The children having moderate mental retardation and their independent living skills can be assessed by scientific method. The aim of our study To find out the levels of achievement in independent living skills of day scholar moderate mentally retarded children Methods and materials The present study is a descriptive research to find out the achievement of independent living skills in day scholars with moderate mental retardation 3-18 years of age in State Institute of Rehabilitation Training and Research (SIRTAR), Gandhi Nagar, Rohtak. The sample consists 20 children from day care with moderate mental retardation. Behavioural Assessment Scale for Indian Children – Mental-retardation-BASIC-MR ( having two parts -Part A and B) find out the levels of achievement in independent living skills. All seven domains BASIC-MR were assessed in day scholar moderate mentally retarded children. Results: Mean score is 375.35 and SD is 54.86. The mean values of language and reading writing domains are higher. The mean values of M, ADL, N.T., D.S. and P.M. domains are lower. Conclusion: Day scholar children remain lack behind in achieving ILS. Therefore this was not an effective service.

Analisis Struktur dan Pola Kalimat pada Karangan Anak Penyandang Tunagrahita Sedang IQ 40-50: Kajian Sintaksis

This study is entitled Analysis of Sentence Structure and Patterns in the Writing of Children with Moderate Intellectual Disabilities IQ 40-50: Syntax Study. The purpose is to determine the writing ability of children with mental retardation by analyzing structure and pattern of sentences obtained from them essays. The data in this study were obtained using listening techniques and skillful fishing techniques. The method used is the orthographic equivalent method. In addition, researchers also used the Distribusional Agih method with the BUL technique. Sources of data obtained in this study came from students of Purnama Asih Special School, people with moderate mental retardation with an average IQ of 40-50 as informants. The results showed that the types of writing for children with mental retardation included single sentences, equivalent compound sentences, and multilevel compound sentences. Equivalent compound sentences and multi-level compound sentences often appear imperfectly.

PRACTICAL ADAPTIVE BEHAVIOR OF CHILDREN WITH MENTAL RETARDATION

How do the children with mild and moderate mental retardation recognize and comprehend the external reality? How do they communicate their abilities of representation and exhibit their competencies? What kind of Practical skills do they possess? With what practical skills do they interact? These are some of the seminal questions in the contemporary discourse on children with mental retardation. This study is an attempt to grapple with some of the above questions, related to the practical adaptive behaviour of children with mental retardation. In social and domestic lives, the practical skills are important, and this article is to study the comparison of various domains of mentally retarded individuals with different degrees of retardation such as mild, moderate, severe, and profound. To carry out this research work a sample of 60 children with mental retardation are randomly selected, from two sub-populations i.e., mild and moderate children with mental retardation. This article mainly focuses on the practical adaptive behavior of children with mild and moderate mental retardation to their level of mental retardation, gender, level of the parent's education, and years of schooling. This research helped us to identify certain gaps in the existing knowledge. It was found based on the conducted research that the majority of the children with mild mental retardation exhibited practical behavior most frequently by participating in most of the classroom practical activities. It is also very important for us to realize that these children whose exceptionalities and disabilities can also be helped with good suggestions so, that they can lead a happy and productive life. From the analysis and testing of the hypothesis, it is evident that the variable 'gender' does not have any influence on children's practical skills. Irrespective of various backgrounds both the boys and girls are equally getting involved in the different practical activities, this may be the reason for the absence of gender discrimination in this context. It can be concluded that children with mental retardation exhibit delays in all aspects of practical skills management compared to non-retarded children and it is felt that if some verbal and non-verbal prompts are provided, these children can manage practical acts well in familiar situations. &#x0D; &#x0D; &lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt; Article visualizations:&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;img src="/-counters-/edu_01/0776/a.php" alt="Hit counter" /&gt;&lt;/p&gt;

Improvement Of Methods Of Providing Dental Care For Children With Mental Delayed Development

In modern society, diseases of the oral cavity are of humanitarian, socio - economic significance. Today, tooth decay and periodontal disease remain the most common dental disease not only among adults, but also among younger populations around the world. According to recent epidemiological studies conducted on healthy children, the incidence of dental pathology is high, with the prevalence of caries among healthy age groups 12-15 years old is 63.3-83 years, 4% and 81.7-88.7%, intensity 3.02 -3.75 and 4.6-5.73, and the prevalence of periodontal tissue diseases in the group of healthy 12-year-old children ranged from 37.8% to 50%, in the 15-year-old group of children it ranged from 57.7% to 84, 7%. The prevalence of caries is also high in children with mental retardation of preschool and school age, while the intensity of caries is higher in children aged 13–18 years with mild mental retardation (MAD). These indicators increase with age and depend on the severity of the underlying disease. We carried out a program for the prevention of dental diseases in children with disabilities, however, most of them were focused on children with mild and moderate mental retardation, where not only the degree of mental retardation was taken into account, but also teaching them oral care skills, the degree of socialization and the child's diet.

Penentuan Kelas Menggunakan Algoritma K Medoids Untuk Clustering Siswa Tunagrahita

So far, the class placement of mentally retarded students is based on the age of entering the child when registering at SLB C Muzdalifah, the Intelligence Quotient (IQ) test has not been tried for mentally retarded students in classifying student classes. It is important to group mentally retarded children to make it easier for teachers to prepare programs and implement educational services. It is important for the school to understand that in mentally retarded children there are individual differences with very large variations. That is, being at almost the same age level (calendar age and mental age) and the same education level, in fact individual abilities differ from one another. Thus, of course, special strategies and programs are needed that are adapted to individual differences. This research was made to classify and analyze data mining for class clustering students with the K-Medoids algorithm to help group students who want to occupy classes according to their level of intellectual disability. From the grouping results obtained 3 clusters, which have the highest number of students is the moderate mental retardation class and the lowest cluster is mild mental retardation, the Muzdalifah special school can prepare classes based on grouping for teaching and learning activities.

Особенности проявления инициативы в общении детей с тяжелыми и множественными нарушениями в развитии

The article presents the results of a study that explored communicative initiative in students with multiple severe developmental disorders using augmentative and alternative communication. The respondents were 11 students on adapted basic general education program for students with moderate, severe, and profound mental retardation as well as multiple severe developmental disorders aged 8.9 ± 1.2. The research was mainly done by observation. The first group of children is the auxiliary language group. It includes children who are still mastering or have already mastered speech; however, their speech is difficult to understand. The second group are the children with expressive language who have a big gap in understanding speech and the ability to independently produce speech. The third group of children includes those who, due to their psychophysiological characteristics, do not understand speech, and, accordingly, cannot speak. The third group is the alternative language group. It was found that in the groups that use alternative and expressive language, the communicative initiative, as a way to attract attention, manifests itself though abstract symbols and is at the stage of formation. To show communicative initiative, children use non-standard pre-symbolic communication. In the auxiliary language group, communicative initiative and attracting attention is also done at the level of abstract symbols and can be either in the process of formation or formed. Besides, in the auxiliary language group, standard pre-symbolic communication is also used. It corresponds to the regular development of communication since such manifestations are socially acceptable and will be used in future communication.

Terapi Okupasi Memasang Tali Sepatu terhadap Motorik Halus pada Anak Tunagrahita Sedang

The purpose of this study was to determine the effect of occupational therapy on attaching shoelaces to the improvement of fine motor skills in mentally disabled children in SLB N 1 Badung. This research method is quantitative research with pre-experimental research design pre-post test one group design. The result of univariate analysis of the intervention of 41 respondents before being given occupational therapy for fine motor development was 1.20, and after being given occupational therapy, fine motor development was 1.41. The results of this study showed the average fine motor development during the pre-test was 1.20. After being given the occupational therapy treatment of attaching shoelaces, the average fine motor development was 1.41. Data analysis results with the Wilcoxon test get a value of 0.003 or p &lt;α (0.05). In conclusion, occupational therapy influences placing shoelaces on fine motor skills in children with moderate mental retardation in SLB N 1 Badung.&#x0D; &#x0D; Keywords: Fine Motoric, Occupational Therapy, Impairment

Kabuki Syndrome: A Rare Genetic Multisystem Disorder in Bangladesh

Kabuki Syndrome (KS) is a rare multisystem genetic disorder. Patients present with unusual facial appearance with mental retardation along with other system involvement like cardiac, renal, neuropsychiatric disorder, hypodontia and post-natal growth retardation. Fundamental characteristics are called 'Pentad of Niikawa' which includes dysmorphic face, skeletal abnormalities, dermatoglyphic abnormalities, mild to moderate mental deficit and post-natal growth retardation. Patients with KS are reported from different parts of globe.