Che cos’è?
La diagnosi di Ritardo Mentale si applica quando si accerta, nel bambino o nell’adolescente (di età inferiore ai 18 anni), un deficit nel funzionamento intellettivo, che inevitabilmente ne compromette l’adattamento e l’autonomia (comunicazione, cura personale, abilità sociali, autogestione). Nello specifico, si fa riferimento all’efficacia con cui il soggetto affronta le esigenze comuni della vita ed è in grado di raggiungere gli standard di autonomia personale previsti per la specifica fascia di età ed il contesto socioculturale ed ambientale in cui vive.
A differenza di disturbi più specifici, il Ritardo Mentale si caratterizza per la pervasività delle difficoltà cognitive, che inficiano inevitabilmente diversi aspetti del funzionamento del soggetto e la sua qualità di vita familiare, sociale, nonché la sua riuscita scolastica e/o lavorativa.
A seconda della gravità del deficit nelle abilità intellettive misurate con le scale standardizzate Wechsler, si classificano ritardi lievi, moderati, gravi, profondi/gravissimi, e non altrimenti specificati (N.A.S.), corrispondenti a specifici livelli di Quozienti Intellettivi (Q.I.).
- Il ritardo lieve è caratterizzato da modeste difficoltà nell’area senso-motoria. Questi soggetti riescono a raggiungere facilmente la quinta elementare ed un livello di apprendimento corrispondente alla prima e alla seconda media. Spesso questi bambini sono isolati, partecipano pochissimo in classe; le difficoltà di comprensione e l’ansia dei genitori o uno stile educativo ipercritico non possono che peggiorare la situazione, provocando a volte balbuzie e tic in situazioni prestazionali.
- I bambini ed i ragazzi che presentano un ritardo moderato, invece, difficilmente raggiungono un livello di apprendimento superiore alle prime classi elementari. Durante l’adolescenza, a causa delle difficoltà nel condividere le convenzioni sociali della propria comunità, mostrano spesso rapporti problematici con i coetanei.
- Nel ritardo grave o severo, il linguaggio è molto approssimato o non affatto padroneggiato, e sono eseguibili compiti semplici ed attività supervisionate. Infine, nei soggetti che presentano un ritardo di tipo profondo sono spesso presenti malattie neurologiche non identificate. Sebbene presentino un certo livello di sviluppo motorio, questi bambini non riescono ad apprendere abilità di autonomia e necessitano di un’assistenza quasi totale.
- Con ritardo mentale non altrimenti specificato (N.A.S.) si indica nei bambini la presenza di deficit multipli per cui è difficile valutare il livello di insufficienza mentale, di solito possibile soltanto attraverso l’osservazione esterna.
Secondo il Manuale Diagnostico e Statistico dei Disturbi Mentali DSM-IV (American Psychiatric Association, 1995), per poter effettuare una diagnosi di ritardo mentale devono essere rispettati i seguenti criteri:
- Criterio A: si riscontra un funzionamento intellettivo significativamente al di sotto della media (QI ≤ 70) valutato con test di intelligenza standardizzati somministrati individualmente; in età infantile, la diagnosi si basa sul giudizio del clinico formulato a seguito di osservazioni comportamentali.
- Criterio B: si osserva un deficit nel funzionamento adattivo attuale evidente in almeno due delle seguenti aree: comunicazione, cura della propria persona, vita in famiglia, capacità sociali/interpersonali, uso delle risorse della comunità, autodeterminazione, capacità di funzionamento scolastico, lavoro, tempo libero, salute e sicurezza.
- Criterio C: l’esordio del disturbo è chiaramente identificabile prima dei 18 anni di età. Diversamente è possibile che si tratti di deterioramento cognitivo.
Quando nasce e chi colpisce?
Il ritardo mentale è diagnosticabile prima dei 18 anni di età, ed è più comune tra i maschi. In assenza di fattori biologici accertati, il ritardo mentale è più lieve ed interessa individui appartenenti a classi socio-economiche più basse.
Perché nasce?
Nella valutazione dei fattori di rischio del Ritardo Mentale, si è tradizionalmente distinto tra fattori biologici/organici e fattori ambientali/relazionali. Quelli maggiormente riscontrati nell’anamnesi clinica riguardano:
- fattori genetici corrispondenti a specifici profili cognitivo-comportamentali differenziabili;
- condizioni psicofisiche della madre in gravidanza (malattie croniche della gestante, abuso di alcool e droghe, nutrizione inadeguata);
- fattori prenatali e perinatali (malnutrizione del feto, nascita pretermine, basso peso alla nascita, emorragie intracraniche o ischemie cerebrali);
- alterazioni precoci dello sviluppo embrionale;
- lesioni cerebrali precoci, responsabili di alterazioni neurobiologiche ed infezioni come l’encefalite e la meningite;
- gravi carenze ambientali (deprivazioni precoci, ambiente gravemente disagiato, condizioni materne di rischio psicosociale).
Quali conseguenze?
In generale, i soggetti con diagnosi di Ritardo Mentale presentano difficoltà sociali, scolastiche e lavorative, oltre che una ridotta autonomia comportamentale. Sebbene l’entità di tali difficoltà vari a seconda della gravità del disturbo, se non adeguatamente trattato, il ritardo mentale rischia di compromettere anche le capacità intellettive possedute dal soggetto.
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