Forum (Spotlight Weekly)

Mental Retardation: Diversified Programs Needed

By Dr. NIRANJAN PRASAD UPADHYAY

Mental retardation is characterized by subnormal intellectual functioning and impaired adaptive behaviour that become manifest during the individual's developmental years. In particular, it refers to subnormal general intellectual functioning that originates during early development and is associated with impairment of learning and other psychological functioning. The retardation may result from genetic defects, brain injury or other organic causes, or psychosocial deprivation. Mental health researchers indicate that people still do not have an understanding of basic health issues and many tend to believe that mental retardation is caused by supernatural causes.

UNICEF, Nepal (2001) stresses that mental retardation emerges due to delayed mental development before the age of 18. All mentally retarded persons are not fully dependent on others for their activities. Chronic mental illness is a kind of mental instability, the symptoms being unprovoked anger or elation and/or crying without reason and a tendency to seek isolation.

The Association for the Welfare of the Mentally Retarded (AWMR), Nepal estimates that there are 720,000 mentally retarded, of which nearly 40 percent are under the age of 14 years. The most common causes of mental retardation in Nepal include genetic birth defects, iodine deficiency, accidents, lead poisoning, lack of environmental stimulation, lack of early intervention, malnutrition, meningitis and malaria. Today, the association has introduced diversified programs and facilities like family counseling, home-visit units, special day care, pre-vocational and vocational centers, especially for coping with retardation problems.

An estimated 10 percent of Nepal's population have some form of disability, of which mental retardation is a major one. The consequences of mental retardation can be reduced through the stimulation provided by special education, including training in self-help skills, social skills, functional literacy and domestic skills. Psychologically, such training can set up the youngster to become an energetic, dynamic and self-determining adult.

Mental retardation is identified on the basis of a standardized intelligence test. Psychologically, application of testing items is a common method of identification of mental level of the individual. An IQ of 70 seems to be the usual upper borderline for those needing special care and training. Retardation is classified according to severity. Those with scores in the upper range of retardation, generally, 36 to 52, are able to talk and care for their own basic needs, able to learn functional academic skills as well as undertake semi-skilled work under sheltered conditions. Those in the severe range of IQ 22 to 35 show diversified problems, i.e. slow motor development, limited communication skills and physical handicaps.

Parental conditions that can lead to growth defects include nutritional deficiencies, drug effects, radiation exposure, disease, and emotional stress. Psychological studies have stressed protein deficiency in mother's diet as cause of lower IQ and other impairments in the children. Mental health researchers have shown that severe malnutrition during infancy not only impairs physical development and lowers resistance to disease, but also stunts brain growth and results in markedly lower intelligence. Psychologists emphasize that birth complications cause bleeding and prolonged pressure on the head during difficult delivery. This may result in brain damage and a wide range of growth abnormalities, i.e. mental retardation, epilepsy, hyperactivity and learning disabilities.

Epidemiological studies focus that the incidence of mental retardation seems to increase sharply at the age of five. During early childhood, a mild degree of intellectual impairment constitutes vast majority of the mental retarded. Their sub- average intellectual functioning becomes apparent only when difficulties with schoolwork lead to a diagnostic evaluation. Special classes are helpful to develop simple skills especially for self-sufficiency within mentally retarded children. Psychologically, early diagnosis of retardation is very fruitful for betterment of child health.

Moderate, severe, and profound cases of mental retardation usually are diagnosed in infancy because of physical malformations, grossly delayed habit training, and other obvious systems of abnormality. In fact, mental retardation tends to run in families. Generally, a number of toxic agents such as carbon monoxide also may cause brain damage during fetal development or after birth. Similarly, certain drugs taken by the mother during pregnancy may sometimes lead to congenital malformation.

Experiments with lower animals as well as observations of humans have made known that deficiencies in certain vitamins, amino acids, and proteins during early development can result in irreversible physical and mental damage. Protein deficiencies in the mother's diet well as in the baby's diet after birth have been pinpointed as particularly potent causes of lowered intelligence. Mental health researchers state that mental retardation is primarily a psychosocial and psycho-educational problem that result a deficit in adaptation to the demands to the demands and expectations of society evidenced by individual's relative difficulty in learning, problem solving, adapting to novel situations and abstract thinking.

Mental health researchers pinpoint that one of the maximum barriers to handicapped young people is that they are expected to be dependent, not just physically, but also socially and emotionally. The problem of preventing mental retardation involves genetic factors as well as wide range of biochemical, neuropsychological and psychological conditions. Inevitably, it is an interdisciplinary problem concerned with human development in general. More adequate medical care for the mother and baby, improved nutrition, specialized educational programs and greater social and economic opportunities are expected to reduce mental retardation.

The World Health Organization says that the quality of effective and congenial relation can improve the individual's emotional, social, substantial, cognitive and physical development. It is a well-accepted doctrine that child is a father of man. So, proper nourishment and effective care of children is necessary for the development of sound mental health. Mental health is a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make contribution to his or her community.

Today, mental health researchers have developed "life skills" educational curriculum, which teaches a extensive range of skills of school age kids to expand their psychosocial competence. The skills encompass problem solving, critical thinking, communication, interpersonal skills, empathy and methods to cope with emotions. These skills facilitate children to build up sound and positive mental health. As a result, they are able to adjust successfully.

UNICEF, Nepal introduced a "A Situation Analysis Of Disability in Nepal" in February 2001. The report clearly defines the multiple layers of deprivation caused by disability and the fact that some 68.2 percent of the disabled had received no education. There needs to be a closer examination of the physical and social barriers to education for the disabled.

There is need for imparting awareness among the community as well as the family members of the disabled persons. Furthermore, there is a need for raising knowledge to the general people about basic health issues pertaining to mental health. It is also an essential to have appropriate approaches like role-play, street dramas, psychological counseling services and health campaigns, especially in the remote areas for communicating lessons about mental health.