1) Who are these little gods?

A child who has certain limitations in mental functioning such as learning, thinking, solving problem; and in adoptive behavior needed to live independently such as communication skills, daily living skills, and social skills (with peers, family members, adults and other), is called as ‘Mental retarded child’. These limitations will cause a child to learn and develop more slowly than a typical child. These people will have more difficulty at home, in school and in the community.

It is a mental disability not a disease which is acquired or communicable. One should note that mental retardation is not a mental illness (viz. mania, schizophrenia, depression, phobia, anxiety, etc). In 1895, the term retarded was used to replace terms like idiot, imbecile and moron. Now, the term ‘intellectual disability’ or ‘intellectually challenged’ is now preferred in place of mental retardation.

2) A. The signs and symptoms

The signs and symptoms of mental retardation are all behavioral. Both adults and children with mental retardation may also exhibit some or all of the following characteristics.

Milestone delays in childhood: Children may take longer than other children in learning to sit up, crawl, walk, run and talk or have trouble speaking. Hence, they may require Speech Therapy and Physiotherapy.

Problem with self-caring of their personal needs: These children can’t do all activities of daily living on their own like bathing, dressing, eating, washing, urination, defecation. They can’t indicate their toilet needs and involuntarily passes stools and urine in their dress; some eat or paste on body the faecal matter after defecation; as a result they suffer from skin and liver diseases. We need to clean and wash - these children; their cloths and surrounding place to prevent from flies being attracted to the faecal matter. Hence, they require special attention at home and special needs schooling.

Intellectual disability: There are many signs of low intelligence in mental retardation. For example, there may be:

  • Delays in oral language development,
  • Do not understand how to pay for things,
  • Deficits in memory skills - find it hard to remember things,
  • Unable to take simple decisions,
  • Unable to attend to specific tasks even for short duration,
  • have trouble in solving problems and thinking logically
  • have trouble seeing the consequences of their actions,

They are likely to have trouble learning in school. They will learn, but it may take them longer time. There could be some things they cannot learn. Hence, they require special schooling.

Behavioral problems: They don’t know how to behave with family members, peers, adults, and others in society. Poor language development and unusual or inappropriate behaviors can seriously impede interacting with others.

  • Don’t know how to communicate with family members, peers, adults, and others in society.
  • Can’t understand what is said and can’t answer to it,
  • Difficulty in understanding and learning social rules,
  • difficulties accepting criticism,
  • Limited self-control.
  • Bizarre and inappropriate behaviors: Susceptible to problem behavior like throwing temper tantrums, banging head, biting self or others.

Children with MR have more behavior problems than children with no chronic or acute health conditions. Hence, they may require behavioral modulation.

Health problems: These people get problems like drooling saliva from the mouth; no bladder control; anemia; epilepsy (Fits) , hyperkinesis (a state of overactive restlessness), and cretinism. A person with mental disability can also have other handicaps like physical, hearing, visual disabilities and articulation deficiencies. Cerebral palsy with MR is one of the commonest forms of multiple disabilities where there is motor disturbances and lack of coordination in movements. Problems with motor skills like walking, sitting, eating, holding glass and drinking water. Main issue with these children is that they can’t express their health problems and changes in the physiology. Hence, they require medical help and; Speech Therapy and Physiotherapy.

These children melt our hearts when we get close to them and look at them with love and affection. We feel like extending supportive service to them. But, we can’t offer them what we like and what they like. Service to a child is specific to that individual, depending on his susceptibility, sensitivity, reactivity, desires, aversions and allergies.

What Causes this?

The most common causes are:

  • Genetic conditions. Sometimes mental retardation is caused by abnormal genes inherited from parents, errors when genes combine, or other reasons. Examples of genetic conditions are Down syndrome, fragile X syndrome, and phenylketonuria (PKU).
  • Problems during pregnancy. Mental retardation can result when the fetus does not develop inside the mother properly. For example, there may be a problem with the way the baby's cells divide as it grows. A woman who drinks alcohol or gets an infection like rubella during pregnancy may also have a baby with mental retardation.
  • Problems at birth: If a baby has problems during labor and birth, such as not getting enough oxygen, forcep delivery, premature delivery. The side effects of medicines, reaction to vaccinations in postnatal period may cause mental retardation.
  • Exposure to certain types of disease or toxins: Diseases like whooping cough, the measles, or meningitis can cause mental retardation if not given enough medical care, or by being exposed to poisons like lead or mercury.
  • Iodine deficiency, affecting approximately 2 billion people worldwide, is the leading preventable cause of mental disability in areas of the developing world where iodine deficiency is endemic. Iodine deficiency also causes goiter, an enlargement of the thyroid gland. If untreated, it results in mild to severe impairment of both physical and mental growth and development. Cretinism is a condition of severely stunted physical and mental growth due to untreated congenital deficiency of thyroid hormones (congenital hypothyroidism) usually due to maternal hypothyroidism.
  • Malnutrition is a common cause of reduced intelligence in parts of the world affected by famine, such as Ethiopia.

The detailed information from the parents is needed before making the diagnosis which includes - detailed history about status of health of the mother during pregnancy; nature and type of delivery of the child and associated difficulties if any; postnatal issues - status of health of child after birth, for example, illness like fever, fits, jaundice, measles; history of similar illness in the family, immunization etc.

Is it a contagious?

Mental retardation is not a contagious disease. You can't catch mental retardation from anyone. Mental retardation is also not a type of mental illness, like depression, mania

Can it be cured?

There is no cure generally for mental retardation. However, most children with mental retardation can learn to do many things. It just takes them more time and effort than other children.

How is it Diagnosed?

Mental retardation is diagnosed by professionals looking at two main things, namely A) the person's mental abilities and B) adaptive skills.

A. IQ test: (Measuring the Intellectual functioning):

Measures the Intellectual functioning i.e. the cognitive ability of a person's brain to learn, think, solve problems, and make sense of the world. Cognition is a group of mental processes that includes attention, memory, producing and understanding language, learning, reasoning, problem solving, and decision making.

The average score is 100. People scoring below 70 are thought to have mental retardation. About 87% of people with mental retardation score above 50 on IQ tests. About 13% of people with mental retardation score below 50 on IQ tests. These people can be classified into following groups-

Psychological Classification IQ

Profound mental retardation

Below 20

Severe mental retardation

20–34

Moderate mental retardation

35–49

Mild mental retardation

50–69

Borderline intellectual functioning

70–84

  • In early childhood, mild mental retardation (IQ 50–69) may not be noticeable and be identifiable until children begin school. People with mild MR are capable of learning reading and mathematics skills to approximately the level of a typical child aged 9 to 12. They can learn self-care and practical skills, such as cooking or using the local mass transit system. They often require training in self-management skills and vocational training in special schools to achieve the levels of performance necessary for eventual independent living. As they reach adulthood, many learn to live independently and maintain gainful employment. Other people may not even consider them as having mental retardation. Even when poor academic performance is recognized, it may take expert assessment to distinguish mild mental retardation from learning disability or emotional disorders.
  • Moderate mental retardation (IQ 35–49) is nearly apparent within the first years of life. In early childhood, milestone delays are particularly common signs of moderate MR. They need considerable supports not only in school but also at home, and in the community in order to participate fully. While their academic potential is limited, they can learn simple health and safety skills and to participate in simple activities. As they reach adulthood, they may live semi-independently with their parents or homes where significant supportive services are available to help them, for example, manage their finances. As adults, they may work in a sheltered workshops.
  • A person with severe or profound mental retardation (IQ < 35) will need more intensive support and supervision for his or her entire life. The greater the severity of the mental disabilities, higher the incidence of behavioral problems. Some will require full-time care by an attendant. They may learn some activities of daily living.
B. Measuring adaptive behavior:

Whether the person has the skills he or she needs to live independently (called adaptive behavior or adaptive functioning). The following skills are the skills important components of adaptive behavior.

  • Daily living skills, such as getting dressed, going to the bathroom, and feeding one's self, self-help;
  • Communication skills, such as understanding what is said and being able to respond;
  • Social skills with peers, family members, adults, and others.

The deficits in adaptive behavior may be reflected in the three areas i.e. during infancy and early childhood, during childhood and adolescence and during late adolescence and adulthood.

(a) During infancy and early childhood in

- Development of sensory and motor skills

- Communication skills (speech and language)

- Self help skills

- Socialization

(b) During childhood and adolescence in

- Use of basic academic skills to activities of daily life.

- Application of reasoning and judgment in the mastery of environment.

- Use of social skills

(c) During late adolescence and adulthood in

- Vocational performances and social responsibilities

To measure adaptive behavior, professionals use structured interviews from people who know them well viz. parents, teacher, and day-care persons. Professionals look at what a child can do in comparison to other children of his or her age. A rating scale is given to each child.

The deficits in the adaptive skills exhibited by a person with mental disability are critical factors in determining the support he/she requires for success in different environments like home, school, place of work and community. Teaching students with mental disabilities appropriate social and interpersonal skills is one of the most important functions of special education.

Then development assessment is done followed by administration of intelligence tests. The child is assessed on the assessment checklist to find out the current level of functioning.

How to rehabilitate them?

After the initial diagnosis of mental retardation is made, we need to analyze that person's strengths and weaknesses to draw a rehabilitation plan for how much support or help the person needs at home, in school, and in the community.

Every child with mental retardation is able to learn, develop, and grow. A child with mental retardation can do well in school but is likely to need individualized help. With the help, all children with mental retardation can live a satisfying life.

Rehabilitation Management Plan: It depends upon the current level of the child and the associated conditions such as epilepsy, Hyperactivity, behavior problem, sensory disabilities and physical disabilities, Etc. The plan varies from infant stimulation, training in activities of daily living (ADL) skills. Further, in cases of MR with physically disabilities, the management includes help in posture, locomotion (Physiotherapy), problematic behaviors and treatment of medical condition.

Management Team: The assessment and management of a case of mental retardation is undertaken by a team consisting of psychiatrist or physical medicine expert, psychologist and a special educationalist. The other members of team included are speech therapist, physico-occupational therapist, social worker and a vocational counselor. After a thorough assessment, the case is referred to either special school wherever possible or home based training or vocational training.

In overall management, there is very significant role for counsellor to help the parents in understanding and accepting the child's problem. This requires a life long adjustment. In order to assist the parents in dealing effectively with the situation, counselling for behaviour modification is essential, as a part of the whole rehabilitation management plan. The focus of counseling depends upon the individual needs and requirement of the mentally retarded and his family.

Early intervention: For children up to age three, services are provided through an early intervention system. Our Family counseling center will work with the child's family and develop an Individualized Plan describing the child's unique needs and the services the child will receive. It emphasizes the unique needs of the family, so that parents and other family members will know how to help their young child with mental retardation. Early intervention services are provided on a free of cost basis in our organisation.

Special education: For eligible school-aged children, special education and related services are made available through the school system. School staff will work with the child's parents to develop an Individualized Programs by identifying the child's unique needs and the services that have been designed to meet those needs. Special education and related services are provided depending on the educational Classification. Educational classification is based on the current level of adoptive functioning and psychological on the level of intelligence of MR.

  • Educable
  • Trainable
  • Custodial

This classification provide an idea of the level at which a mentally retarded person functions in relation to his education, appropriate behavior and the degree of his independence.

Many children with mental retardation need help with adaptive skills, which are needed to live, work, and play in the community. Teachers and parents can help a child work on these skills at both school and home. Some of these skills include:

  • Communicating with others;
  • Taking care of personal needs (dressing, bathing, going to the bathroom);
  • Health and safety;
  • Home living (helping to set the table, cleaning the house, or cooking dinner);
  • Social skills (manners, knowing the rules of conversation, welcoming, getting along in a group, playing a game, traveling );
  • Reading, writing, and basic mathematics;
  • As they get older, skills that will help them in the workplace.

Problems in families having disabled children.

Psychosocial problems are faced by parents and other family members with a mentally retarded child are many in India where the birth of a disabled child is viewed as an unfortunate event. Social stigma and discrimination add to the suffering of the family members impacting their social engagements and even the interactions with neighbours.

Disruption of the family life: There will be extraordinary ‘time demands’ created in looking after the needs of the disabled child. Those families perceived greater financial stress, frequent disruption of family routine and leisure; poor social interaction esp. in meeting friends and attending functions of the relatives; chronic stress and its ill effects on their physical and mental health as compared to families of control children.

Maternal neuroticism: Mothers of MR children undergo different levels of depression called ‘maternal neuroticism’ which is manifested by characteristics of anxiety, moodiness, worry, envy and jealousy. It is a higher-personality dimension related to poor stress coping, irrational thinking, poor impulse control, mood disorders and worry.

Parental stress: The mothers and fathers feel significant stress of future parenting. The tension within parents arises due to contradictory emotions and beliefs about the disability. It may lead to divorce or suicidal tendencies among them.

Appropriate management of these problems should be part of rehabilitation programs i.e.

Family counseling

The positive effects on family as told by some families in surveys, are-
  • “The experience has made us come to terms with what should be valued in life”.
  • “Having a disabled child has led to an improved relationship with spouse”.
  • “Raising a disabled child has made life more meaningful for family members.”
  • “The child's disability has led to positive personal development in mother and/or father”.
  • “The experience has brought us closer to God”.

All these depend on the financial status, educational levels and understanding levels of the family members.