ADVERTISEMENTS:
ADVERTISEMENTS:
This article throws light upon the top ten methods of treatment for mental retardation in humans. The methods are: 1. Education 2. Trainable Mentally Retarded Children 3. Residential Placement 4. Psychotherapy 5. Individual Psychotherapy 6. Group Therapy 7. Behaviour Modification 8. Observational Learning 9. Prevention 10. Secondary and Tertiary Prevention.
Method # 1. Education:
(a) Educating parents
ADVERTISEMENTS:
(b) Educating the mentally retarded.
(a) Educating parents:
Mental retardation strikes the parents much harder than it does the retarded child itself. Because of the personality difficulties and problems of adjustment of the retarded child, many parents consider their life to be miserable.
However, while some parents ignore the mentally retarded child, others go out of their way to help him to the extent of overprotecting him. This, on the contrary, makes one child completely unfit to learn or achieve anything.
The parents therefore should be properly trained as how to handle the mentally retarded child. No doubt the mentally retarded child should be given proper love and affection. But this should not amount to something like overprotection and overindulgence. The parents must be sympathetic but at the same time they should be strong on certain points.
Their child rearing practices, values and ideas should not be inconsistent and paradoxical. Their attitude towards the subnormal child should not be conflicting or rigid either. He should be given all opportunities for adequate play, open space and toys which are attractive, safe and strong.
He should also be encouraged to help in the household chores so that he can develop some sort of self confidence and sense of achievement. He should be praised for his accomplishment, whatever it may be.
(b) Special education for retarded:
ADVERTISEMENTS:
Special education provides reasonable help to educate the mentally retarded children.
For the purpose of special education, retarded people may be classified into two groups:
(1) The educable mentally retarded (EMR) and
(2) The trainable mentally retarded (TMR).
EMR children have the I.Q. range of 55—70. They can go up to the 3rd to 6th grade by the time they complete school education. The aim of their education is to take care of them independently.
Special small classes are conducted for EMR children where they are taught to learn social competence and occupational skills rather than academic achievement as is usually done in normal schools. Specially structured teaching materials are also prepared for the mentally retarded.
Robinson and Robinson (1976) have reported special classes and programmes are conducted for people of different age groups. Students are taught vocational and domestic skills. They are taught to deal with everyday problems such as use of money, reading newspapers, application for jobs etc.
Method # 2. Trainable Mentally Retarded Children:
TMR children are much more retarded than EMR children and so their educational structure and curriculum are different. They have I.Q. in the range of 25-55. They are mainly taught to take care of themselves and to do simple occupational jobs. Regular schooling is difficult rather impossible for TMR children because of the physical problems in the severely retarded group such as seizures, lack of control over elimination etc.
In fact, the aim of TMR classes is to teach them basic skills that normal and EMR children learn as they grow. The basic aim of TMR education is to teach these severely retarded children how to do their daily work like washing and dressing themselves, eating properly, doing simple jobs, toilet training etc.
However, it is unfortunate to state that in many cases TMR education becomes a failure in the sense, they learn nothing more than what they would have learnt at home. Krick (1972) emphasising the service of special classes has remarked that it relieves the parents of retarded children of some responsibility and helps them to see their children’s disabilities more realistically.
Kirk has further viewed that the effects on children of TMR classes are hard to assess. He said, “Invariably, the children improved from year to year, but whether this improvement stemmed from the programmes or from maturation was hard to know”.
For the education of mentally retarders individual-centred programmes are conducted at the Institute of Defectology in Moscow, U.S.S.R. First the child is diagnosed as retarded by the age of 6 months. From that age till the onset of puberty individual programmes from the multi-disciplinary points of view are prepared and implemented for the child. And it is said that with the onset of puberty, the retardation is overcome.
Though it is quite difficult, time-taking and costly to manage individual based programmes in developing countries like India; at-least attempts should be made on an experimental basis if not in individual units.
Some psychologists and educationalists have argued normalization of education of retarded children. It refers precisely to the concept of main streaming which is of very recent origin.
Particularly they hold this view for EMR children. On the other hand, they claim that special education for mildly retarded children may only develop a complex in them that they are inferior and different from others. They would feel and look more different than they are.
Thus, they argue that mildly retarded children should be taught in regular classrooms instead of placing them in separate classes and imparting special education. One of the important advocates of normalization of education of EMR children, Dunn opines the past and present practices of special education are morally and educationally wrong.
Robinson and Robinson (1976) have further supported the normalization of education of mentally retarded children. They view that the special class room is an ‘isolating experience …………………… Children from special classes within regular public schools are avoided by other pupils and often feel lonely, unwanted and negatively valued.
On the contrary in the normalisation approach, EMR children play with their normal peers and classmates and feel that they are one among the entire group. It is also viewed by Robinson that EMR children are “better able to achieve socially and academically if they are exposed to models than their own.”
Retarded children placed in regular classrooms may be less disturbed than those forced to remain in special classes. It is also a fact that regular classes bear a greater resemblance to the real world. It is more reality-oriented. Finally, mentally handicapped children help other children to understand and accept them. Consequently the retarded child gets better scope for emotional security and adjustment.
Research findings on the efficiency of mainstreaming’s are very few. In view of its recent origin, Mesibov (1976) has reported that the data evaluating mainstreaming has been generally mixed.
MacMillan, Jones and Meyes (1976) have found that inspite of special components of mainstreaming programme, teacher’s attitude towards retarded children in the mixed classes may be the primary determinant of the success of normalisation programmes. MacMillan, suggest that the principle of mainstreaming be separated from its implementation.
Today, however, all special education has not ceased. Rather modern education for the EMR child involved a combination of special and regular classes. According to Duke and Nowicki (1979) special classes may be helpful when a child is learning to adjust to school and regular classes may be taken a few hours a day in certain subjects.
Pioneers of mainstreaming view that the goal on mainstreaming is to fit the EMR child as much as practicable back to his normal peer group.
Method # 3. Residential Placement:
Earlier it was also known as institutionalisation. Residential places deals with the total control of the retarded person’s life, his private and personal experiences. It removes the retarded persons from their home environment and places them in an artificially made environment suitable for their personality development.
Here they may reside either permanently for a period of time till they are cured. Usually majority of the severely and profoundly retarded persons need institutionalization.
In fact, this comes to about 4 per cent of the mentally retarded people who need residential placement. In U.S.A. in 1972 it was 190,000 out of 6 million mentally retarded people. More often than not the effects of residential placement has been found to be adverse particularly where custodial care is prevalent and where drugs are administered in plenty to control deviant behaviour.
However, the positive effects of institutionalisation have been reported by Clarke and Clarke (1953) Jigler Butterfield (1970) Balla, Butterfield and Ziglar (1974) found the effects of institutionalization varied with the individual’s pre-institutional life experiences, the environment of the particular institution and the diagnostic skill of the investigator.
One alternative to the residential treatments is the ‘group home.’ It is a type of boarding house in which a fixed number of retarded people stay together with some professional staff who look after them. They live here as normally as possible learning simple vocational tasks, taking part in group therapy.
The group home is much better than the large institutions and it has many of the facilities of real home for the retarded person. There are also day care centres and sheltered workshops. The day care centres train the children who are too young and too retarded to remain in institutions or to be trained in other community programmes.
In sheltered workshops, vocational training is given so that the person can get a job. In U.S.S.R. and U.S.A. there are many sheltered workshops to meet the demands of the retarded persons. In India, however recently, the Dept. of Social Welfare has provided financial assistance to states to open institutions to provide vocational rehabilitation to the mentally retarded.
Some private and semiprivate institutions have started this work which is nevertheless very meagre in view of its demand. Vocational rehabilitation centres should be opened on a large scale in India to meet the demands of mentally retarded in India.
Compensatory education is another type of training aid for the mentally retarders. It attempts to prevent the developmental psychological defects which interfere with educational progress.
It specially helps in the prevention of cultural familial retardation by imparting structural programmes on sensory and language stimulation for the development of achievement motivation, problem solving skills and interpersonal relations. The mothers of children also receive training in understanding, caring and managing the retarded children adequately.
Method # 4. Psychotherapy:
Psychotherapy deals successfully with the emotional problems and problems of maladjustment, as well as psychological symptoms. It is a well established fact that mentally subnormal people demonstrate a number of psychological problems and complexes which can be reduced by psychotherapy alone.
True, they face greater amount of stress in their day to day life in comparison to other normal people. Thus, they show symptoms of anxiety, irritation, anguish and finally aggression and violence.
On other occasions, they show depression and anxiety which aggravates their already retarded mental condition. Sometimes, the psychological problems become so acute that education, special training or institutionalization has no impact upon them.
Under these circumstances, psychotherapy becomes a very effective method of treatment. Usually, individual psychotherapy, group psychotherapy, behaviour modification and observational learning are included under psychotherapy.
Method # 5. Individual Psychotherapy:
It includes one to one relationship between a trained psychiatrist in the area of mental retardation and the retarded person. It may be verbal or non-verbal depending upon the subnormal person’s age, capacity for reception and degree of retardation.
Nonverbal individual therapy includes play therapy advocated by Leland and Smith (1965, 1972) where structured and unstructured play materials are combined to match the necessity of the retarded person. While structured material is useful for mild cases, non-structured play therapy is effective for severely retarded person.
Besides play therapy, occupational therapy, music therapy and art therapy may be included. Verbal psychotherapy is applicable to those retarded persons who are capable to communicate in words with the therapists. They usually are mildly retarded adults. For the success of individual psychotherapy the rapport and the relationship between the therapist and the client is the most paramount factor.
Method # 6. Group Therapy:
Proofs are there to show the advantages of group therapy over individual therapy. Group therapy is said to be a more economical method of treatment. Secondly, the group atmosphere is conducive to safe practice of the technique relating to peers and friends which may be ignored in individual therapy.
Lastly, group therapy provides individual members with models and examples for better adjustment. It also recreates a sense of safety, we feeling and togetherness which can be of great help psychologically speaking to the retarded person who is in-secured, frightened and depressed.
Method # 7. Behaviour Modification:
During the recent years behaviour modification has proved to be a very effective technique in treating the mentally retarded persons. It involves, to be more precise, the principles of reinforcement and punishment for modification of behaviour. By applying suitable reinforcements the behaviour modifier can change the behaviour of the mentally retarded person in the desirable direction.
Behaviour modification includes:
(a) Averse conditioning where punishments are given whenever the behaviour becomes undesirable;
(b) Token economics where points earned for good behaviour are rewarded through money, candy or story books etc.
According to the reports of Gardner (1970) many professionals believe that behavioural methods have been the most effective form of treatment for the problem of the mentally retarded person.
Method # 8. Observational Learning:
By this technique new models or examples are presented to the retarded persons and the retarded persons are to change themselves according to these models. Researches on imitation learning by Bandura (1969) show that it has been possible to teach moderately and severely retarded subjects the basic skills of using the telephone through observational learning communicating simple ideas to peers.
Studies as well as observation show that with attractive models and clear instructions almost all retarded children can learn through imitation.
Method # 9. Prevention:
It has been observed that prevention is better than cure and the best treatment of mental retardation is prevention. On the whole, by preventing metabolic disorders, toxins and alcohols from pregnant mother’s birth and environmental hazards can be prevented to a great extent.
The specific factors which help in the development of mental retardation and need to be prevented are as follows:
Primary prevention:
(a) Education and propaganda to increase the knowledge of the public and awareness of mental retardation.
(b) Systematic and continuous efforts of health professionals to ensure and upgrade public health policies.
(c) Legislation to provide optional materials and child health care.
(d) Family and genetic counselling to the family members with a history of genetic disorder with mental retardation.
(e) Proper prenatal and postnatal medical care for the expectant mothers particularly of the low socio-economic status.
Method # 10. Secondary and Tertiary Prevention:
This refers to immediate treatment of the disorder. Delay in treatment should be avoided as otherwise it will lead to prolonged illness. Early treatment for Phenyl Ketonuria hydrocephalis and cretinism may reduce the percentage of onset of mental retardation.
Hereditary and endocrine disorder can be successfully treated if detected at an early stage, by means of dietary control and hormone replacement therapy. Through modified psychiatric treatment emotional and behavioural difficulties of the mentally retarded can be effectively treated through modified psychiatric treatment techniques.
In addition to this, the retarded children should be given more social group interaction and behaviour therapy. Psychotropic medicines may be of some help to reduce effectively anxiety depression and hyperactive/impulsive behaviour.
Lastly, the parents of mentally retarders should also be given continuous counselling and family therapy to deal with the child and also to deal with their own feelings of despair, anxiety, guilt, anger and denial relating to their retarded child with patience and determination. Finally, practice of early intervention appears to be of great help to the retarded children and families.
It has been observed that in many cases prevention is better than cure. By preventing metabolic disorders, toxins and alcohols from pregnant mothers and other births, environmental hazards, mental retardation can be prevented to a great extent through education and propaganda. Early treatment for phenyl ketonuria hydrocephalis and cretinism may probably reduce the percentage of onset of mental retardation.