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After reading this article you will learn about: 1. Concept of Mental Retardation 2. Classification of Mental Retardation 3. Factors 4. Mental Retardation and Adjustment Problems 5. Social Psychological Factors 6. Assessment of the Mentally Sub-Normal 7. Statistics 8. Conclusion.
Concept of Mental Retardation:
With increased knowledge, higher education, community and fellow feeling the attitude of the society towards mentally retarded and handicapped persons has gradually changed in the positive direction. People have attempted to deal them with sympathy and consideration.
Attempts have been made by Government and Private institutions and organisations to take special care of the mentally retarded persons. Of late, several institutions and special schools have been opened for the training of the retarded.
The first organised programme for the retarded was started in 1837 by a French psychiatrist named Seguin. The first school for such children was opened in Massachusetts in 1848, followed shortly by another school in New York and then in Pennsylvania and the first professional organisation now known as the American Association on Mental Deficiency was started by Medical Officers of institutions in 1876.
In India, the first institution for mentally retarded was started in Bombay in 1941. In 1975 it increased to 160. This increase in the number of schools indicates the concern of the government and public for mentally retarded persons. But in view of the large number of mentally retarded in India, this number is quite negligible.
Mental retardation has been referred to differently by different psychologists and psychological associations. For example, British psychologists like Cyril Burt (1955) and Clark and Clark (1973) and the WHO (1954, 1967 and 1968) have used the term ‘subnormal mind’. However, WHO has preferred the term retardation instead of subnormal mind in the recent revision of ICD- 9.
The American Psychiatric Associations on the other hand prefers the term mental deficiency in place of mental retardation. Nevertheless, most of the contemporary psychologists and psychiatrists like to use the terms mental deficiency or mental retardation.
In this article we will use the term mental retardation. The American Psychological Association has defined mental retardation (Mental Deficiency) “as significantly sub average general intellectual functioning existing concurrently with deficits in adaptive behaviour and manifested before the age of 18”.
Mental retardation according to English law is a condition of arrested or incomplete development of mind existing before the age of 18 years whether arising from inherent causes or induced by disease or injury.
According to Tredgold (1937) “it is a state of incomplete mental development of such a kind and degree that the individual is not capable of adopting himself to the normal environment of his fellow in such a way to maintain existence independently of supervision, control or external support.”
The WHO (1954) defined it as “incomplete or insufficient general development of mental capacities”. The American Association of Mental Deficiency refers “to mental retardation as significantly sub average in general intellectual functioning existing currently with deficits in adaptive behaviour and manifested during the developmental period.”
Mental retardation has been defined by IDC-9 as “a condition of arrested or incomplete development of mind especially characterized by sub-normality of intelligence.” Mental retardation is not considered as a disease but a condition with deficits in adaptive/social functioning which has a developmental origin.
Based on the AAMD definition, DSMIII-R definition states that mental retardation is a state of significantly sub average general intellectual functioning resulting in or associated with concurrent impairments in adoptive behaviour and manifested during developmental period.
Thus DSM III-R describes the essential characteristics of mental retardation as follows:
(a) Significantly sub average general intellectual functioning.
(b) Significant deficits or impairments in adoptive functioning.
As it appears, all these definitions emphasise at one point and that is intelligence. But the definition given by AAMD which has emphasised both intellectual and adaptive ability has been the most widely accepted definition of mental retardation.
Mental retardation has merely been considered as a symptom by Robinson and Robinson (1976) that may result from a variety of physically and socially based disorders all of which manifest themselves in reduced intellectual functioning and hampered abilities to adapt to the requirements of every-day life.
Thus, mental retardation not only refers to less intelligence, but also reduced capacity to adjust and adopt with the needs and necessities of everyday life. According to Duke and Nowicki (1979) the AAMD definition of retardation is presented in such a way that it is possible to ascertain the degree of retardation by using standardized tests such as the Wechsler Intelligence scales (AMMI), adaptive behaviour scales.
A retarded child is very hyperactive. He is constantly on the move, has short memory and poor concentration. He has frequent mood changes. He may be laughing at one moment and crying at another moment. Anxiety makes him ritualistic. He wants to do everything exactly in the same way. Change of any kind puzzles him and he gets angry.
Classification of Mental Retardation:
By administering intelligence tests mentioned above or suitable alternatives, one can determine the specific classification of mental retardation.
Intelligent Quotient (IQ):
Stern pointed out that the intelligence of a person could be expressed as a ratio between the mental age and the chronological age.
The mental age when divided by the chronological age would give Intelligence Quotient, he viewed. For the purpose of convenient calculation.
It is multiplied by hundred. Thus, the formula to calculate I.Q. is MA / CA x 100.
Old Classification of Mental Retardation:
French psychologist Alfred Binet (1905) made the first attempt to classify mental retardation in terms of intelligence.
I.Q. between 90—110 average
80—90 dull/normal
70—80 border line
Below 70 feebleminded.
The feeble minded was again classified as
I.Q. from 50 to 70 — Morons
25 to 50 — imbeciles
below 25 — idiots.
The American Association of Mental Deficiency in 1973, changed the terms moron, imbecile and idiot which were thought to be derogatory. This classification of mental retardation is only based on the I.Q. level and it has already been discussed that I.Q. alone does not help an individual to adjust with the everyday circumstances of life.
Because of this deficit, a new classification of mental retardation was subsequently developed by the American Psychological Association.
Currently 4 categories of mental retardation are developed. According to the level of retardation, classification is made and it is expressed mainly in terms of intellectual ability.
Factors on Mental Retardation:
Several causative factors of mental retardation have been described. Mainly, genetic, physical, social and psychological factors have been associated with the occurrence of mental retardation. According to Linford Rees (1970), David Stafford Clark (1964) at least 5 per cent of the babies born turn out to be retarded at the time of birth.
The retarders constitute about 1 to 4 per cent of all school children and about 3% of the children aged between 6 to 16 years. The prevalence is seen between 10 to 14 years. This traditional belief on the prevalence of M.R. in general population has been challenged recently by western studies. Birth cohort studies from Scandinavian countries have consistently indicated that the prevalence of M.R. is about 1 per cent.
The regional variation (between 0.4 per cent to 1.5 per cent) is found only in mild M.R. category. But the prevalence of severe M.R. is same all over the world being 3 to 5 in one thousand. Very few systematic studies have been conducted in India on the prevalence of this disease in the general population.
The available data can be summarised as follows:
Verma (1968) screened 30,326 persons of Nagpur city and found that the rate of M.D. per thousand is 30.1. In 1970 Gupta screened 8,583 persons of Lucknow (both rural and urban) and the prevalence of M.D. was 23.3 per thousand.
Subrahmanya (1983) made a screening of 1498 rural children (3—15 years) of Bangalore and the prevalence rate was 27.4 per thousand.
On the whole nutritional factors like pre and post natal under nutrition, environmental factors such as sensory or cognitive deprivation or both, socio cultural factors like social disadvantage, lack of access to health services appear to play paramount role in the onset of mild M.R. as observations indicate that there is over representation of mild M.R. among children born to mothers who were under-nourished during pregnancy.
The genetic and physical factors come under the organic causes and the social and psychological factors come under the environmental causes. The organic factors by and large explain the moderate and severe retardation and the environmental factors account for the mild and moderate retardation.
Genetic Factor:
A number of genetic syndromes associated with mental retardation always play their role at the time of conception. The genetic syndromes affect adversely the intellectual or physical capabilities and also the physical appearance of the victim.
The genetic defects arise partly due to extra chromosomes or mutant chromosomes and partly due to the function of the dominant or recessive genes leading to mental retardation.
Mainly two important genetic syndromes, such as Down’s syndrome and phenylketonuria have important roles to play in mental retardation:
(a) Down’s syndrome:
It is also known as Mongolism. It is by far, the most frequently recognised syndrome, representing in every 660 births of the population. According to Robinson and Robinson (1976) it is probably the single most common chromosomal cause of moderate to severe mental retardation.
This disorder increases with the increase in the age of the mother, specially after 40 years. The older the mother, the greater is the chance for mongolism.
Secondly, there is significant increase in the risk if the mother has already delivered a mongoloid baby. The syndrome is mainly caused by a genetic defect in one of the chromosomes and the symptom of mental retardation can be present at the age of one year.
The physical deformities of children suffering from mongolism are slanting eyes, flat face, and nose, large and deeply fissured tongue, irregular and disproportionate teeth, legs and arms, pro-trading belly small skull, underdeveloped genetalia etc. They are very sort. Majority of the Mongolians have 47 chromosomes instead of 46.
They have the I.Q. between 40 to 54 (moderately retarded) and they do not need hospitalization. They can comfortably stay at home. According to the reports of Belmont (1971) the Down’s syndrome children show less psychological disturbances in comparison to other categories of mentally retarded.
They show improvement in their condition in a more secured and warm family atmosphere full of love and affection than in an institution. To put in a different way, they do better in a family where there is emotional support and affection. Given proper encouragements adult mongoloids do not create any problem.
Rather they are able to perform household work. According to Benda (1946) such children are described “lovable little creatures full of affection and tenderness.”
(b) Phenylketonuria (PKU):
PKU was first described by Foiling (1934), a veterinarian. PKU is caused due to a genetic error. Here the enzyme responsible for the metabolism of the biochemical phenylalanine is not present at birth. As a result, severe brain damages are produced consequently in mental retardation.
According to the reports of Murdock (1975) the occurrence of PKU has been found to range from one in every 6,800 births to one in every 14,000 births.
The average I.Q. of children with PKU is approximately 50 which suggests that the majority of them remain in the moderately to severely retarded range. Usually, the PKU baby appears to be normal for the first few weeks after birth. But at about 6 months of age various motor complications appear.
There is delay in several motor functions like sitting, standing and walking etc. and so much so that even some of them never learn to walk. Unlike the Down’s syndrome children, the PKU children create psychological complications. They may be wild, fearful, restless and finally uncontrollable. They are so hypersensitive that they require constant restraint and hospitalization.
The adverse effect of PKU can be prevented if the disease is dictated immediately after birth. This can be done by a simple blood or urine test of the baby at birth. If PKU is detected, the neonate can be immediately administered a special phenylalanine free diet. This early restriction in diet usually prevents severe retardation.
According to the report of Berman and Ford (1970) successfully treated PKU children perform within the average range of intelligence. The collaborative study of children treated for PKU (1975) reports that in 95 per cent of cases, neurological examinations are normal at ages 2 to 4 and that IQs are within the average range.
Environmental Hazards:
The environmental hazards related to the prenatal, natal and postnatal periods of life may be discussed.
i. Prenatal Hazards:
(a) Maternal malnutrition during pregnancy:
In a study of animals it was found by Winick and Rosso (1972) that malnutrition in pregnant rats results in about 15 per cent reduction in the number of brain cells in their offspring. They also found that malnutrition in humans resulted in significantly lower birth weights in infants. Lower birth weight also suggests lower brain weight and reduced intellectual ability.
(b) Maternal infection:
According to Hellman and Pritchard (1971); 5 per cent of the pregnancies may be accompanied by some viral infection having their dangerous effects upon the unborn during the first 3 months. Due to this infection, certain damaging agents get in causing measles, chicken pox, small pox, polio and rubella.
Rubella is said to be one of the most acute infection leading to mental retardation. Chess, Korn and Fernander (1971) have reported moderate mental retardation in 25 per cent of rubella infected children and mild retardation in another 25 per cent such as deafness, cataract and malformation of the heart Vaccination against rubella for pregnant women and women of child bearing age has fantastically reduced the incidence of rubella in pregnant women.
Similarly chronic maternal infections like herpes infection and syphilis also produce mental retardation in the offspring. This can be prevented by proper medical diagnosis and treatment prior to the 18th week of pregnancy.
Toxoplasmosis can also cause severe neurological damage to the fetus. Moreover, after birth infectious diseases like encephalitis and menincoceal meningitis may cause irreversible brain damage and finally mental retardation.
(c) Intoxication and use of unsafe drugs:
Shephasd (1974) has found that 20 drugs in the minimum can produce defects in the unborn child which may lead to mental retardation. Carbon monoxide, lead, arsenic, quinine and other substances may lead to mental retardation.
Thalidomide may produce limbless, eyeless retarded babies in 20 per cent of the woman using it. Thus, the use of unsafe drugs may bring genuine damage to the unborn child in the form of mental retardation.
Similarly, investigations also indicate that alcohol taken by pregnant women leads to mental retardation. Studies by Jones, Smith, Streissguth and Myrain lhopoulos (1974) have indicated the harmful effect of alcohol on the children born from female alcoholics. The use of small pox and thyroid vaccines or inoculation with antitetanus serum may lead to neurological disorder and mental deficiency.
Milkovich and Vandenberg (1974) have reported the adverse effect of minor tranquilisers such as chlordiazepine and Meprobamate (Lebrium and Miltown). Similarly, Rh incompatibility, increased age, radiation poisoning and stress in the mother also lead to subnormal mental development Injuries prior to birth may also have adverse effects upon the fetus.
ii. Natal Hazards:
The various hazards and injuries during the birth process refer to natal hazards resulting in mild retardation. The natal hazards are usually of 3 types.
Premature birth:
Babies under 5.5 pound birth weight suffer from several physical and mental difficulties. So much so that, according to Niswander and Gordon (1972) the death rate for low birth weight infants is 25 times greater than for normal weight infants. The rest who survive, the rate of neurological abnormality is 3 times higher than the normal weight babies.
In addition to this, Goldman, Kufman and Liebman (1974) have found that out of 55 children, weighing less than 3 pounds at birth, at age 5, only 30 per cent were attending regular schools.
Anoxia or lack of oxygen during the birth process may lead to mild retardation. Robinson and Robinson (1976) have viewed that though there are a few controlled studies on anoxia in humans, studies in monkeys have demonstrated that anoxia can be associated with permanent brain damage.
Graham, Ernhert, Craft and Berman (1963) have indicated that children with a history of breathing difficulties showed more neurological abnormalities and intellectual disorder than normal controls. Due to this dysfunction of the liver in the newborn, a disease called Kernicterus occurs which also lead to mental retardation.
Liver dysfunction arises when the degree of biochemical called bilirubin reach a high level in the child’s body resulting of mental retardation as well as serious damage of brain cells, muscular disorders and seizures. The adverse effects of kemicterus can be avoided by blood transfusions and special lights to metabolize bilirubin.
iii. Postnatal Hazards:
The physical hazards occurring shortly after birth also lead to mental retardation. Accidental head injuries lead to mental retardation depending upon the degree of damage. The more the damage, the more severe is the retardation.
Infections of the brain during the postnatal period may lead to mental retardation. Encephalitis and meningitis lead to mental retardation. However, early diagnosis and treatment may reduce the probability of mental retardation.
Cranial Neoplasms Brain Tumours:
The mental and intellectual functioning, headaches, loss of vision and seizures may occur due to brain tumour. The adverse effects of brain tumour or mental retardation can be reduced by early diagnosis and treatment of the disease.
A tumour in the brain may also lead to hydrocephales, i.e. accumulation of abnormal amount of cerebrospinal fluid in the Cranium. Infants with hydrocephales have an obstruction of the narrow channels and the fluid which continues to be formed, accumulated above this block expanding the head with resultant increasing compression and destruction of brain tissue.
Similarly, macrocephaly, (large headedness) and microcephaly (small headedness) occur due to abnormal and arrested growth of brain.
Today it is felt that about 50 per cent of the hydrocephalic patients if treated early can be salvaged for normal mental and neuromuscular development. Besides these causes, cretinism or mental deficiency of thyroid gland function has long been recognised as a cause of progressive mental retardation, which if untreated little children grow horrible dwarfness in both mind and body.
Experiments in the later part of the nineteenth century demonstrated this phenomenon.
It was also found that thyroid hormone has iodine in it and that a certain amount of iodine is essential in the diet for normal hormone production. So the iodination of regular table salt especially in those areas and countries with endemic cretinism is a most remarkable nationwide programme for the prevention of mental retardation.
A suspected case of cretinism can be verified by specific blood test. If the missing thyroid hormone is given by the mouth starting with the first few months of life, normal mental and physiological growth is expected.
Mental Retardation and Adjustment Problems:
The mentally retarded person has to face several adjustment problems in his day to day life:
1. Feeling of inferiority, unworthiness, mild depression and helplessness is experienced.
2. He is unable to adjust with social groups and friends and cannot cope with them. He has a great need for personal friends and companies. But it is not fulfilled and so he is frustrated. This frustration of psychological as well as social needs makes him more angry and rebellious.
The parents develop a guilt feeling because of the mentally retarded child. They blame themselves for bringing to the world such a handicapped child. This very feeling leads them to take excessive care of him through over-protection.
Consequently, the child develops a feeling of dependence. Over protection also creates adjustment problem for the child. Another way of expressing the guilt feeling is denying the child’s disabilities.
Social Psychological Factors of Mental Retardation:
Certain socio-psychological factors are also responsible for causing mental retardation. This has been called by Grossman (1973) as retardation due to psycho-social disadvantage. Indicating the relationships between socioeconomic level and lowered intellectual abilities. Vogt (1973) says that in children from lower S.E.S. illiteracy rates may be as much as 3 times the national average.
Cassell (1973) further reports that the incidence of mental retardation is consistently higher in poor urban areas. However, from this alone it cannot be concluded that economically and educationally deprived children are prone to mental retardation.
Some surveys in India indicate that poor and rich are more or less equally afflicted by mental retardation. Among the economically disadvantaged people we find poor diet and nutritional deficiency, particularly in calcium and proteins.
Cases of untreated infections like meningitis, syphilis, whooping cough lead to mental retardation. Studies by Benda (1983) and Heber (1970) indicated that the families of the retarded were educationally backward and economically deprived.
Similarly, in the high S.E.S. group in India, resistance to medical termination of pregnancy, (M.T.P.) is another cause of mental retardation. To add to this, emotional starvation of the child due to long and continuous isolation from parents during early childhood, leaving the child with the servants and baby sitters, avoiding breast feeding, precipitated mental retardation in higher income groups.
i. Physical Health:
Poor physical health of the lower S.E.S. group and their inability for proper food and treatment may lead to mental retardation. Bauer (1972) has found that various birth and environmental hazards and infectious diseases affect more the poor class. The pregnant mothers of the poor class rarely get proper care and food. There is hence greater risk for mental retardation of their child than the affluent and rich mothers.
ii. Home Environment:
Inadequate home environment may be of the important causes of mental retardation. Socially disadvantaged people have unsuitable home environment for the proper development of the child. He may be more prone to diseases and damages in such unsuitable home environments.
iii. Attitude:
Socially, economically disadvantaged people are overburdened with their own worries and anxieties. They usually transmit a sick feeling, a feeling of displeasure and unhappiness which is not conducive for proper mental development. On the contrary, they pave way for mental retardation.
They are to be more precise, culturally deprived and do not get stimulating environment for proper mental development. These children may not be able to adjust well at school and may lag behind. They may not also be able to grasp the feedback. Lack of proper experience, stimulating environment along with necessary attitude for learning stands on the way of formal schooling.
iv. Parent Child Relationship:
The type of parent child relationship, prevalent in different social groups determines the degree of mental retardation. Psychologists believe that generating a feeling of rejection in the child, giving him an unwanted feeling and pressurizing him may lead to mental retardation. Thus, in U.S.A. 3% of children are mentally retarded while in India it is between 0.07 to 2.50 per cent.
In lower and lower middle socio-economic groups, both the father and mother go out to earn their living as the father’s pay packet alone becomes insufficient to maintain the family. Consequently when mothers go out to work, the responsibility of the child falls either on the servant or baby sitter or older sibling or a relative.
Keeping this in mind, White and Watt (1973) have remarked, “One arrangement of this result is that the interchanges necessary for successful parent child relationships often are missing and intellectual social and emotional growth can be hampered.”
While some parents ignore the mentally retarded children, others take extra care and go out of the way to help them to the point of overprotecting them thus making them completely unfit to learn and achieve anything. The child should be given love and warmth. But this should not amount to something like overprotection or indulgence. The parents should therefore be sympathetic, but nonetheless, firm and consistent.
This will elevate the growth of useful habits and attitudes in the child. Early emotional deprivation and disturbed parent child relationship has a possible role to play in mental retardation. Emotionally in secured children usually become oversensitive to stresses and strains of life and become susceptible to mental retardation.
Because of mental deprivation the rate of growth and development is arrested and one becomes more susceptible to environmental stress and the adaptability capacity decreases. Lack of social, emotional and motivational support for child prepares ground for mental retardation.
Besides the above factors influencing mental retardation, there are also some other common factors. They are high blood pressure, syphilis, severe nutritional deficiency, repeated X-rays and excessive drugging of the mother during pregnancy.
Unusually prolonged labour and other abnormal conditions of delivery including brain injury after accidental conditions and dangerous abortive methods may also lead to mental retardation.
Assessment of the Mentally Sub-Normal:
It is an essential necessity to assess the sensory, motor, language, cognitive areas and overall personality of the retarders to identify the disables among the retarders. For this purpose, the cooperation from doctors, educationalists and psychologists is essential.
The job of the physician is to find out the genetic information, the prenatal, mental and postnatal history of the child, experiences of the mother during pregnancy and labour, blood group, incompatibility, infections and other allied factors. The educationalist or teacher has thus to give his own observations and experiences and the problems with regard to the child.
The psychologist, finally has to play a major role. He has to measure the general intelligence and mental ability of the child. In India, to assess the mental ability of the young children, usually Gessel Developmental Schedules, the Cattell Infant Intelligence Scale and the Bayley Scales of Infant Development are used.
The Standford-Binet and the WISC are used for children and adolescents. To find out whether a deaf child is retarded or not, the Nebraska Test of Learning and Aptitude, the Performance Scale of WISC and the Draw-A-Man Test or the Arthur Performance Scale is used. In testing a blind child, the Hayes-Binet intelligence Test and the Maxfield Buckhoiz Social Maturity Scale are used.
Personality problems and difficulties in adaptive behaviour are some of the main problems of a mentally subnormal child. These can be assessed by using various tests such as the Adaptive Behaviour Scale, the Minesota Developmental Programme System and the Nebraska Client Programming System.
Several evidences suggest that retarded persons of all ages particularly the severe retarded one have high prevalence of associated psychiatric disorders which are diagnosable.
Reasons for high psychiatric disorder in the retarded persons are indicated as follows:
1. Impairment of CNS contributes to both M.R. and behavioural disturbances.
2. Psychologically unhealthy conditions of upbringing are a cause of behaviour disturbance.
3. High vulnerability to traumata which is intrinsic to M.R. are a cause of behaviour disturbance.
4. Epilepsy and additional speech handicap contribute significantly to the behaviour disturbance.
The above factors either separately or in combination could play a role in the causation of behaviour disturbances.
Statistics of Mental Retardation in India:
Prior to the International year of the Disabled (1981) in India, there was no nationwide statistics available regarding the incidence of mental retardation. Of course, some small scale surveys were conducted which give the percentage of incidence of mental retardation ranging from 0.7 to 4 per cent in India.
However, recently survey made during the International year to the Disabled (1981) in India, indicated that approximately 3 per cent of the population are mentally retarded. Among these 3 per cent, one per cent comes under the severely retarded category. However, when the incidence of cases of mental retardation recorded in all hospitals of Madras was taken into account, it was found to be 3 per cent of the total cases recorded.
Mental retardation accounts for 50 to 75 per cent of the work load of the 54 child guidance centres in India. The adult retarded constitute about 1 to 3 per cent of the total adult population. Mental sub-normality is therefore a problem of the childhood and is essentially a problem of the school going children.
From a child population of about 6 millions it has been calculated that approximately 2 million children are mentally Retarded which means 33 per cent of the child population are placed in the mentally retarded category, while only 3 per cent of the total population is in that category.
It has further been estimated that about 70 per cent of the mentally retarded population is based in the rural areas where no help is provided to the mentally retarders. In most of the rural schools and some urban areas many of the borderline cases of mental retardation are bypassed as dull students.
By and large, about 80 per cent of all mental retardation is of mild or moderate category. Severe retardation constitutes only about 5 per cent of the total retarders and needs institutional care in the Indian context i.e., there are about 14.24 to 15 million children in India who need special educational help. About 0.75 to one million children need custodial care that offers habit training and simple socializing experiences.
As surveys show, most of the severe degrees of mental retardation come from the higher educational and income groups. On the other hand, the mild and moderate degrees of sub normalities are found in the underprivileged and socially disadvantaged classes. The male retarders outnumber the females, the ratio being 2: 1 which has been explained as sex linked inheritance.
Surveys of schools in the underprivileged areas of some big cities of India like Delhi, Lucknow and Bombay have revealed that about 3 to 8 per cent of children studying in Corporation Municipal Schools are slow learners, with evidence of intellectual sub normalities.
Prabhu (1970) conducted a survey in Delhi and pointed out that 85 per cent of the parents of the retarders sought advice from quacks. Further it is interesting to note that less than 1/5th of the parents in the survey had any real idea about the potentiality of their children.
In India, though there is no proper record of the number of institutes serving the mentally retarded there are about 120 such out of which less than half are residential. Apart from these schools there are a number of day care institutions run by private persons.
Recent Development in India:
Fortunately people at all levels in India have been quite aware of the problem of M.R.
Thus, there have been many positive developments and improvements in the prevention and care of the mentally retarded individuals in India as would be evident from the following:
(a) National Mental Health Policy (NMHP) recognises mental retardation as a severe mental morbidity requiring priority in attention and care.
(b) National Policy of Mental Handicap (NPMH) formulated in 1988 is considered as a significant document for the care of the mentally retarded in India.
(c) National Institute for the mentally handicapped (NIMH):
Since its establishment at Secunderabad in 1984, NIMH is doing commendable work mainly in the areas of Para professional and professional training in M.R.
(d) Innovative Method of Care:
Several experiments and surveys have been conducted to find out suitable methods of detection and care of MRS and training of Para Professionals by Narayanan (1988), Krishna Murthy (1987), Singh (1982), Mehta (1984), Data (1986) and many others.
(e) Social Benefit for the Families:
Income tax exemption, concessional railway tickets, monthly Pension (in some states) and job reservation for handicapped persons have been introduced by the State and Central Govt. for the benefit of retarded persons and their families.
Education and Training:
Several schemes like integrated education of Disabled Vocational Rehabilitation centres and District Rehabilitation Centres for education and training of the mentally retarded persons have been introduced.
Some very effective work has been conducted on the role of families in M.R. with reference to the needs, perceptions, attitudes and impact of parents. More recently, a work has been made on different forms of family intervention.
While Singh and Mehta have employed behaviour modification models, Giri Maji et al. and Peshawar, et al. have reported on counselling models. Verma and Sesadri have reported a more comprehensive intervention package incorporating several models. Narayanan et at- have reported a new innovative model which is based on family adaptation, transactional and behaviour models.
A study conducted at Niloufer Hospital, Hyderabad needs special mention. This is an on-going project of early intervention modelled along Portage project sponsored by UNICEF which is the first large scale project of early intervention.
Mentally retarded persons have everywhere been considered as second class or even third class citizens. Society in the past has always behaved with them in the most inhuman manner. The mentally retarded persons have always been ridiculed and resented.
Conclusion to Mental Retardation:
Mentally retarded persons have everywhere been considered as second class or even third class citizens. Society in the past has always behaved with them in the most inhuman manner, the mentally retarded persons have always been ridiculed and resented.
However, of late, the situation has changed to some extent. Social attitude has taken a different turn. They are now dealt with sympathy and understanding. The International Year for the Disabled (1981) has raised the consciousness of the people and their duties and responsibilities to mentally retarders.
Retarded children are no more debarred from taking admission into any public school after the Federal Legislation was passed which guarantees the right of all children to a free public education. Thus, throughout the United States retarded people have got the opportunity to enter into improved public education programmes.
Previously which was a dream, now has become a reality. As a result they can integrate themselves into the educational, social and cultural mainstreams.
In the familial sphere the rationale of parental involvement has developed recently. A retarded child in the family presents a lifelong problem. The family has to accept the child as he is rather having feelings of guilt, sorrow and anguish. Feelings of shame and rejection can aggravate the case of the retarded child further.
Given proper attention, love and care many mentally subnormal children show tremendous improvement. In various institutions and homes for mentally retarders, children have been taught various skills like tailoring, book binding, gardening, carpentry, washing and the like.
With all these facilities even if the retarded person achieves economic independence, he still needs social adjustment and social recognition. For this, he has to face terrific difficulties. To add to this, he finds it more difficult to adjust to the demands of the culture in which he lives.
Things are said to be improving. But it appears that more many years will be needed before the mentally retarded child integrates himself into the main stream, i e., into the normal society.
There is a wide variety of occupations in which the retarded persons can work more efficiently than workers of average intelligence, probably because of their stability and steadiness. Their love for repetitiveness makes them ideal for monotonous jobs which are rejected by the normal as boring.
Thus, it is high time that the attitude of the society should change more and more in the positive direction towards mental retardation. This can be made possible through electronic and mass media. More and more motion pictures and T.V. serials should be produced and screened for the development of a positive and sympathetic altitude towards the mentally retarders.