Mental Retardation
Introduction In this disease the child’s mental growth is retarded i.e. development does not take place according to age. Causes Before birth: - Maternal infections, like Syphilis, Rubella, Toxoplasmosis, Influenza, Jaundice, drugs and certain medicines. Genetic Disease Mental retardation is also an inherited illness, which in certain conditions is transferred from parents to children. During Labour If during labour the child gets injured by any means or birth is delayed. After Birth Severe Jaundice, skull injury, meningitis, and thyroid problems. Complaints The mental capabilities do not match with children of the same age. The Milestones of Development are delayed i.e. sitting, standing, walking and talking. During school age the child is not able to understand the books of his class. He has problems in learning and remembering. Normal developmental of healthy children: 1. Can grip things at the age of one month. 2. The neck can support the head at 3 month’s age. 3. Can sit and crawl at age of 6 months. 4. Can stand and walk at age of 1 year. 5. Can speak at age of 2 years. But those who are mentally retarded start doing all these functions late and even then not as good as other children of same age. Mental retardation is often accompanied with visual defects, hearing and smelling problems, and weakness in the body. The child cannot concentrate on studies at school, cannot comprehend what is taught, and it seems as if he is not paying attention. Poor performance of the child in school annoys parents a lot. After hard efforts the child learns but then soon forgets. Parents and child get exhausted but without any result. Parents resort to punishment in an effort to force him to learn but the result is even worse. Teachers in school face the same problem. At home they won’t follow clear-cut directives and perform work in a hap-hazard manner. Sometimes they become irritable and restless and at times epileptic fits accompany and accentuate this problem. According to severity they can be classified as: (i) Severe type In this type the child can’t take care of himself. He need the help of others, even for personal hygiene. Such children suffer from various physical and nervous ailments. They may not be able to stand up or walk. They can’t recognize their relatives, and often can’t inform about urination and toilet needs. They need supervision and care for all the life. Their life expectancy is low. Their body’s defensive mechanism is adversely affected so they fall prey to diseases very easily. They need to be hospitalized in special kinds of hospitals, which Pakistan, doesn’t have as yet, except for a small institution known as “Darus sakoon” on Kashmir road in Karachi. (ii) Moderate type They can’t take care of themselves properly, and need constant attention and help of others. They can also have some physical defects. While speaking they feel difficulty in choosing appropriate words and have difficulty in speaking clearly. Very weak in education, they can’t comprehend the lessons and tend to forget soon. They perform daily routine work with difficulty like eating on their own, wearing clothes or shoes, or telling about urge for urination and defecation, washing face, taking bath and they also lack in social manners. (iii) Mild Type They can study up to a primary level but are not capable of higher education. They can learn simple skills, but need help and guidance from others. With great difficulty they can pass Matric. These children can go undetected by parents and teachers for many years. The elders try to force them by scolding and punishment to perform better which means there are many years of turmoil in the life of the child as well as the parents, with anger and frustration on all sides. What is needed is proper intelligence estimation of the child and a plan for his future education and vocational training accordingly. Parents are initially reluctant to accept that their child’s intelligence is below normal, for all the grand plans they had for him are threatened. However they must be made to realize that the longer they delay the intellectual assessment the lesser will be the chances of the proper education and vocational training of the child, for a child can be tutored and molded in the earlier years much more than in adolescence or adulthood. We need to administer intelligence tests to such children for the accurate estimation of their condition. Although intelligence (I.Q.) test are available in advanced countries, unfortunately none has been made or adapted and standardized in Pakistan. Even non-verbal tests have not been imported from the west as they are very expensive. If is only after three or four years of school education that parents finally decide to take the child to a psychiatrist. By then the child is at least nine or ten years of age. If the following questions are asked, a rough estimate of the child I.Q. can be made. Questions to assess intelligence 1. Can the child take care of his personal needs: washing after urination, defecation, putting on his clothes, eating food, etc. 2. Counting from one to hundred. 3. Tables from two to nine. 4. Simple sums of addition, subtraction, multiplication and division. 5. General knowledge about Pakistan: population, capital, biggest city, number and names of provinces, name of President and Prime Minister, population of the city he lives in (Karachi). The name of the founder of Pakistan, year and date of the establishment of Pakistan. 6. General knowledge about the world: number and name of continents, name of Head of State of USA, Russia, India; any other heads of countries he knows. In which countries are New York, London, Beijing, Tokyo & Delhi etc. Prevention Mental retardation can’t be treated by medicines. Prevention is better than cure. Before marriage consult doctors if retardation is found in the family. To avoid mentally retarded offspring seek genetic counseling if already married in a family which has mentally retarded persons. Pregnant women should avoid medicines specially in the first trimester If ill during pregnancy, consult a qualified doctor, do not take medicines without medical advice. Get children Immunized so that diseases do not effect the brain. Delivery should be performed by a trained mid-wife or doctor. Get immediate medical advice if the child gets fever with fits. After delivery immediate blood examination can detect the chemical deficiency Phenylketonuria, so that at the initial stage one can treat and prevent mental retardation due to that abnormality. This blood-screening facility is available at the Agha Khan Hospital, Karachi. People in other cities can also send blood for examination by post. Medication There is no medicine available to improve mental performance. Due to the pressing demands from the family, doctors often prescribe medicines which, are not of much help, and on the other hand are expensive i.e. encephabol and hydergine. Other symptoms like fits and restlessness can be treated by medicines. These medicines could be given for as long as needed. Counseling At times Psuedo mental retardation occurs due to anxiety and family conflicts, and then counseling is also needed. Training If mental retardation is not due to psychological problems, following steps should be taken: First evaluate the degree of retardation i.e. mild, moderate, or severe. Then plan accordingly for mental, physical, social and educational training. Discussion with parents and teachers the level of education that should be the goal. A field of training should by chosen so that when the child grows up he can earn his living and not be a burden on others. If a timely plan is not made and the child is pushed to perform like other children of his age, in educational and practical fields, then the mentally retarded child will develop in addition mental illnesses. Delay in proper training will also result in the child remaining unskilled, defective, and a burden on the family. These children need education and training according to psychological principles i.e. educating them with love and affection. No punishment should be inflicted. This is even more important and beneficial for the retarted ones than it is for the normal ones. When they make an effort at learning a word of praise or a gift item like a biscuit or toffee, some money etc. should be given to the child for encouragement. Education should be imparted in the mother tongue. At first teach important chores and simple tasks only. Reading, simple writing, and easy mathematics should be the initial goal of the educational process. These children can’t adjust in a normal school, so they should be admitted in special schools, or better still educated at home by a caring tutor. They need guidance in education so that they can learn according to their capacity and become responsible citizens. Skill These children can’t adopt the skill of the parents’ choice. They can do only that which is within their ability and capacity, that is why they should be made to learn easy skills, so that they may be able to earn their living and not be a burden on others. |
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