Facts and Figures

Mental Retardation : from knowledge to action

What is Mental Retardation?

What happens when the brain fails to mature and grow ?

Naturally, such babies fail to develop and acquire milestones like normal children. These conditions, in which there is a significant deficit or delay in the development of various mental functions from early childhood, are called developmental disabilities.

One can recognize different types of developmental disabilities, depending on what function or functions are affected and how extensive is the limitation.

Mental Retardation: This is a condition in which there is delay or deficiency in all aspects of development, i.e. there is global and noticeable deficiency in the development of motor, cognitive, social, and language functions. This is the commonest form of developmental disability. In many ways, mental retardation is also representative of developmental disabilities in general, in its causation, nature, and care.

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Cerebral Palsy: In this condition, there is gross delay in the development of motor functions. Children with cerebral palsy have great difficulty in initiating and controlling their muscles and body movements. Many of these children are perfectly well in all other aspects, such as in their speech, learning ability and socialization. This differentiates cerebral palsy from mental retardation. In addition, their legs and arms may appear too stiff or too limp.

The main form of treatment of cerebral palsy is through physiotherapy and stimulation. By these methods, motor development can be enhanced and complications such as contractures of muscles prevented. In a small number of children, medical and surgical methods can be used to reduce the stiffness so that movements become easier.

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Language Developmental Disability:  Some children develop well in all other aspects except speech. This happens even though their hearing is normal. Many of these children are able to understand what is spoken to them, but they are slow in learning to speak. These children can benefit substantially through speech therapy. The techniques of speech therapy can be learnt by parents and practised at home. A majority of children with this condition grow up to be normal.

            
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Autism: This is a rare disorder in which children fail to develop the ability to relate and interact with people. They tend to be lost in their own world and remain indifferent to people around them. They have poor eye contact. They may develop some limited speech, but fail to use it for communicating with others. They tend to spend most of their time repeating the same activities again and again. The main form of treatment for autism is behavioural training to improve social, communicative, and self-help skills.

Dyslexia:  In this condition, the level of intelligence is normal or above average; yet, such children have difficulty in doing well in studies. This happens because even though the child is otherwise intelligent, he has significant disability in learning the three R's of reading, writing, and arithmetic. This condition should not be confused with mental retardation, because these children retain their learning ability in other areas such as language, sports, and social and artistic skills. They often get unnecessarily blamed as being lazy and uninterested in studies. The problem is complicated by their tendency to avoid school work as they find it unrewarding.

This condition can be corrected to some extent by specialized methods of teaching. It is also very important that children with dyslexia are given full encouragement to develop their talents and skills in non-academic areas.

Attention Deficit Hyperactivity Disorder: All children are active, but a few are overactive and considered hyperactive. They may sleep only a few hours at a time. When awake, they are impulsive, constantly in motion, darting from one activity to another, often failing to sustain attention in simple tasks or

games. Such children often have Attention Deficit Hyperactivity Disorder (ADHD).
             
ADHD affects at least 1-2% of all school-age children. ADHD is 4-8 times more common in boys than it is in girls. Undiagnosed and untreated, it wreaks havoc on a youngster's sense of self-esteem and interferes with his/her ability to perform well at school, to make friends, and to get along with siblings and parents.

               
S.V. Krithika

A comprehensive treatment programme taking a holistic view of the individual with ADHD is needed. This requires decisions regarding administering medication and behaviour therapy strategies. Often teacher training, parent training, family therapy or individual counselling is needed.

Conduct disorders: Conduct disorder is defined as a “repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate societal norms or rules are violated.” The group of behaviours characteristic of conduct disorder include aggressive behaviour that may cause physical harm or injury to people or animals, theft, violation of rules and destruction of property. It is believed that approximately 1 to 2% of children under 18, especially boys, suffer from conduct disorders in SEAR Member Countries.

The intensity and duration of these behavioural problems in children has significant repercussions in family, social and academic areas. Conduct disorder may be associated with other mental disorders, including ADHD, depression and learning disorders. Severe psychosocial factors, such as family disharmony, low socioeconomic level, harsh parenting patterns and child abuse, may also be responsible. The strong influence of the media, especially television and rapid social and family system changes, could also play a role in precipitating and maintaining the morbidity level of conduct disorders in children.

During evaluation, children with conduct disorders are typically hostile and easily provoked. A careful assessment of the family, school and personal dimensions should be undertaken. Management involves a holistic approach with emphasis on behaviour modification via teachers and parents. Unchecked, conduct disorders may lead to antisocial traits, substance abuse and even criminal behaviour in adulthood. Prognosis may be good in cases where there is support from the family and the social network.         

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More about mental retardation

As noted earlier, mental retardation is a condition in which there is a significantly sub-average mental development from birth or early childhood. Most people with mental retardation have the condition from birth. In a small number, the condition may occur following damage to the brain in later childhood. This could, for example, follow an episode of brain fever.

Mental retardation is also termed as mental deficiency, mental sub-normality, and intellectual deficiency. Terms that are also used include idiot, imbecile and moron. These insulting and demeaning terms should not be used.

Generally, mental retardation is a life-long condition. Those affected continue to have diminished intellectual capacity throughout their lives. However, in most individuals with mental retardation, those parts of the brain that are not damaged continue to develop. Therefore, they continue to acquire skills and abilities as they grow older, albeit slowly.

Mental retardation is not mental illness. The major characteristic of mental retardation is delay in mental development, whereas the major characteristic of mental illness is disturbance in the mental functions of thinking, feeling, and behaviour. Mental illness can occur at any age, whereas mental retardation is present from childhood. However, some people with mental retardation may also develop mental illness.

Degrees of mental retardation

Not all people with mental retardation have the same level of intelligence. The scientific method of measuring intelligence is through standardized psychological tests called IQ tests. IQ or intelligence quotient, is the percentage of intelligence a person has, in comparison to a normal person from a similar background. An IQ of 100 is considered normal intelligence. The lesser the IQ, the more severe is the level of mental retardation. Based on IQ, mental retardation can be classified into different degrees as follows: 

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A more practical and simpler way of classifying mental retardation is to think of only two categories: mild mental retardation with an IQ range of 50-70, and severe mental retardation with an IQ below 35. Though the concept of IQ is useful in some ways, it does not always give the true picture of the abilities of the person. A related and more appropriate measure is the social quotient (SQ), in which importance is given to the acquisition of socially relevant skills.

Functioning and development of people with mental retardation

Table 1 illustrates the attainments of people with different degrees of mental retardation in adulthood. It is clear that even those with severe mental retardation can become at least partly independent in looking after themselves through proper supervision, care and training.

Table 1

Adult attainments in different degrees of mental retardation

Note:  + means attainable: ++ means definitely attainable: +/- means sometimes attainable