A study on prevalence of minor physical anomalies in mentally retarded children in a tertiary care centre of India


  • Mithun C. Konar Department of Pediatrics, Burdwan Medical College, Burdwan, West Bengal, India
  • Kushal Karmakar Department of Pediatrics, Burdwan Medical College, Burdwan, West Bengal, India
  • Kamirul Islam Department of Pediatrics, Burdwan Medical College, Burdwan, West Bengal, India
  • Kaustav Nayek Department of Pediatrics, Burdwan Medical College, Burdwan, West Bengal, India
  • Archan Sil Department of Pediatrics, Burdwan Medical College, Burdwan, West Bengal, India




Intelligence quotient, Mental retardation, Minor physical anomalies, Waldrop weighting score


Background: Paucity of studies in world literature and lack of any Indian study assessing the frequency, prevalence and severity of minor physical anomalies (MPAs) in children with mental retardation (MR) as well as their importance for prediction and timely recognition of mental insufficiency, if any.

Methods: A cross-sectional observational study involving 273 mentally retarded children aged 5-18 years was conducted over a period of one year and were compared with their age and sex matched controls. Waldrop and Halverson (1971) physical anomaly scale was used to assess those MPAs.

Results: In the study group, higher percentage (79.85% vs. 40.29%) of children had MPAs with a predominance of multiple MPAs in comparison to healthy children (40.29% and 0%, respectively). Higher average frequency of MPAs per child was noted in the study group (1.42) than control group (0.40). Mean Waldrop weighting score was significantly higher among mentally retarded children than their controls (3.7±0.8 versus 0.8±0.2, P<0.0001). Authors noticed a gradual and significant decrease in Waldrop score with increase in intelligence quotient (IQ) [F=175.72, P<0.001]. A significant strong negative correlation between Waldrop score and IQ level (r=-0.89, P<0.001) was also observed. Out of eighteen variables of Waldrop score, seven were found as significant in binary logistic regression model for MR. Our model can explain 37.6% to 50.1% variability of the MR.

Conclusions: MPAs are more prevalent in mentally retarded children than healthy children.  A clear-cut demarcation between these two groups is possible by the frequency of anomalies and the increased strength of their expression (i.e. their weighting scores).


Luckasson R, Coulter DL, Polloway EA. Eds. Mental Retardation: Definition, Classification, and Systems of Supports. 9th ed. Washington, DC: American Association on Mental Retardation; 1992.

Van Karnebeek CD, Jansweijer MC, Leenders AG, Offringa M, Hennekam RC. Diagnostic investigations in individuals with mental retardation: a systematic literature review of their usefulness. European J Human Genetics. 2005;13(1):6.

Shapiro BK, Batshaw ML. In: Intellectual Disability. Kliegmann RM, Stanton BF, St Geme III JW, Schor NF eds. Nelson Text Book of Pediatrics. First South Asia edition. New Delhi, Reed Elsevier India Pvt Limited; 2016:216-222.

Bhattacharyya R, Sanyal D, Roy K, Bhattacharyya S. Correlation between physical anomaly and behavioral abnormalities in Down syndrome. J Pediatr Neuro Sci. 2010;5(2):105.

Ulovec Z, Skrinjaric T, Jukic J, Skoko-Poljak D, Vrancic ZR. Minor Physical Anomalies in Children with Hearing Impairment and Normal Controls. Coll Antropol. 2012;36(4):1257-64.

Griffiths T, Sigmundsson T, Takei N, Frangou S, Birkett P, Sharma T, et al. Minor physical anomalies in familial and sporadic schizophrenia: the Maudsley family study. J Neurol Neurosurg Psychiat. 1998;64:56-0.

Opitz J, Mendez H, Hall J. Growth analysis in clinical genetics. In: Papadatos C, Bartsocas C, eds. Endocrine Genetics and Genetics of Growth: Progress in Clinical and Biological Research. New York, Alan R. Liss, Inc; 1985;200:33-64.

Ulovec Z, Skrinjaric I, Sosic Z, Szirovicza L, Jukic J. The prevalence of minor physical anomalies in mentally retarded children. Coll Antropol. 2002;26:119-128.

Trixler M, Tényi T, Csábi G, Szabó G, Méhes K. Informative morphogenetic variants in patients with schizophrenia and alcohol-dependent patients: beyond the Waldrop Scale. Am J Psychiat. 1997;154(5):691-3.

Hoyme HE. Minor anomalies: Diagnostic clues to aberrant human morphogenesis. Genetica.1993;89: 307.

Smith DW, Bostian KE. Congenital anomalies associated with idiopathic mental retardation: Frequency in contrast to frequency in controls, in children with cleft lip and palate, and in those with ventricular septal defect. J Pediatr. 1964;65(2):189-196.

Marden PM, Smith DW, Mc Donald MJ. Congenital anomalies in the newborn infant, including minor variations. J Pediatr. 1964; 64:357-71.

Weinberg SM, Jenkins EA, Marazita ML, Maher BS. Minor physical anomalies in schizophrenia: a meta-analysis. Schizophrenia Res. 2007;89(1-3):72-85.

Minahim D, Rohde LA. Attention deficit hyperactivity disorder and intellectual giftedness: a study of symptom frequency and minor physical anomalies. Rev Bras Psiquiatr. 2015;37(4):289-95.

Lloyd T, Dazzan P, Dean K, Park B, Fearon P, Doody GA, et al. Minor physical anomalies in patients with first-episode psychosis: their frequency and diagnostic specificity. Psychol Med. 2008;38(1):71-7.

Firestone P, Peters S, Riviere M, Knights RM. Minor physical anomalies in hyperactive, retarded and normal children and their families. J Child Psychol Psychiat.1978;19:23-26.

Ulovec Z, Šoši, Z, Škrinjari I, atovi A, Civljac M, Szirovicza L. Prevalence and significance of minor anomalies in children with impaired development. Acta Paediatr. 2004;93:836-40.

Waldrop MF, Halverson GF Jr. Minor physical anomalies and hyperactive behavior in young children. In: Hellmuth J, ed. Exceptional infant: studies in abnormalities. Vol. 2. New York: Brunner/Mazel.1971: 2:343-380.

Hata K, Iida J, Iwasaka H, Negoro HI, Ueda F, Kishimoto T. Minor physical anomalies in childhood and adolescent onset schizophrenia. Psychiatry Clin Neurosci. 2003;57:17-21.

Laufer MW, Denhoff E. Hyperkinetic behavior syndrome in children. J Pediatr. 1957;50:43.

Firestone P, Prabhu AN. Minor physical anomalies and obstetrical complications: their relationship to hyperactive, psychoneurotic, and normal children and their families. J Abnorm Child Psychol. 1983;11:207-16.

Green MF, Satz P, Christenson C. Minor physical anomalies in schizophrenia patients, bipolar patients, and their siblings. Schizophr Bull. 1994;20(3):433-40.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV. 4th ed. Washington (DC), American Psychiatric Association; 1994:866. Available at: http://www.psychiatryonline.com/DSMPDF/dsm-iv.pdf.

Baird PA, Sadovnick AD. Mental retardation in over half-a-million consecutive livebirths: an epidemiological study. Am J Ment Defic. 1985;89(4):323-0.

Firestone P, Peters S, Rivier M, Knights RM. Minor physical anomalies in hyperactive, retarded and normal children and their families. J Child Psychol Psychiat. 1978;19:155-160.

Burg C, Rapoport JL, Bartley LS, Quinn PO, Timmins P. Newborn minor physical anomalies and problem behavior at age three. Am J Psychiat. 1980;137(7):791-6.

Waldrop M, Bell R, McLaughlin B, Halverson C. Newborn minor physical anomalies predict short attention span, peer aggression, and impulsivity at age 3. Sci. 1978;199:563- 565.

Waldrop M, Bell R, Goering J. Minor physical anomalies and inhibited behavior in elementary school girls. J Child Psychol Psychiat.1976;17:113-22.

Waldrop M, Goering J. Hyperactivity and minor physical anomalies in elementary school children. Am J Orthopsychiat. 1971;41:602-7.

Lal R, Sharma S. Minor physical anomalies in schizophrenia. Indian J Psychiat.1987;29:119-22.

Steg J, Rapoport J. Minor physical anomalies in normal, neurotic, learning disabled, and severely disturbed children. J Autism Child Schizophr.1975;5:299-307.

Waldrop M, Halverson C. Minor physical anomalies and hyperactive behavior in children. In: Hellmuth J ed. Exceptional Infant: Studies in Abnormalities. New York, Brunner / Mazel; 1971,Vol 2: 343-380.

Firestone P, Lewy F, Douglas V. Hyperactivity and physical anomalies. Can Psychiatr Assoc J. 1976;21:23-6.

Rosenberg JB, Weller GM. Minor physical anomalies and academic performance in young school children. Dev Med Child Neurol. 1973;15:131-5.

Elizarraras-Rivas J, Fragoso-Herrera R, Cerdan-Sanchez LF, Ramos-Zepeda R, Barajas-Barajas LO, Troyo-Sanroman R, et al. Minor physical anomalies and anthropometric measures in schizophrenia: a pilot study from Mexico. Schizophrenia Res.2003;62(3):285-7.`

Seller MJ, Bobrow M. Factors involved in genesis of congenital abnormalities. In: Keeling JW ed. Fetal and neonatal pathology. New York, Springer-Verlag Berlin Heidelberg; 1987, 1st Eds.123 -133.

Firestone P, Peters S. Minor physical anomalies and behavior in children: A review. J Autism Dev Disord. 1983;13(4):411-425.

Dimambro B, Lloyd T, Dazzan P, Dean K, Fearon P, Doody GA, et al. 2–The association between minor physical anomalies and IQ in first episode psychosis. Schizophrenia Res. 2008;98:33.






Original Research Articles