Case study: Mental Retardation

Introduction

When you go out from your house today, try to observe the people around our environment, and we will found that not everyone cans physically function like us or at normal level. For instance, there are individual who blind, deaf are, and also who are not able to speak or move around. Generally, people refer them as physically disabled, so we will see this group of people having the special privilege such as in the shopping complex’s parking space, special parking was prepared with the label “disable”. On another hand, there are people who can’t mentally function at normal level like most of us. They might have not able to control their body movement, their intelligence, social interaction as well as language since the birth or early childhood. In this case, we are referring them as mental retardation.

The American Association on Mental Retardation (2002) defined mental retardation as a particular state of functioning that begins in childhood and characterized by limitation in both intelligence and adaptive skills. According to National Information center for children and youth with disabilities (2002), we label a person with mental retardation when he or she has specific limitation in mental functioning and also in skills such as communicating, taking care of him or herself as well as social skills. All of this limitation will cost the children in their learning, such as slow in learning and development comparing to others typical child (National Information center for children and youth with disabilities, 2002). Mental retardation also reflects the “fix” between the capabilities of individuals and the structure and expectation of their environment (The American Association on Mental Retardation, 2002). In specific example, children with mental retardation may need longer time in learning to speak, walk, and take care of their personal needs such as eating or dressing (National Information center for children and youth with disabilities, 2002). They are more likely to have problem learning in normal school (National Information center for children and youth with disabilities, 2002). They can learn, but probably needed a longer time or else there are something that they just can’t learn (National Information center for children and youth with disabilities, 2002). Mental retardation is sub-average general intellectual functioning that related with concurrent impairments in adaptive behaviour and manifested during the developmental period (Southern association of institutional dentists, 2010). Mental retardation is an effectual theoretical intelligence, which is congenital or acquired early in life (Stefanovska, Nakova, Radojkova-nikolovska, & Ristoska, 2010). Children with mental retardation have the low rate of understanding and limited domain of attention (Rezaiyan, Mohammadi & Fallah, 2007). The 34 Code of Federal Regulations 300.7(c)(6) of The United State’s Department of education defined mental retardation as significantly sub-average general intellectual functioning, existing concurrently with deficits in adaptive behaviour and manifested during the developmental period, that adversely affects a child’s educational performance (Federal registration, 1999).

The statistic showed that averagely, 3% of the general population will be suffered from mental retardation (Southern association of institutional dentists, 2010). Most people with mental retardation are diagnosed before or during first years of school (Southern association of institutional dentists, 2010). The prevalence provided by statistical manual of mental disorders fourth edition text revision [DSM-IV-TR] (2000) mentioned that mental retardation has been predictable at roughly 1%. In term of gender, the ration for male to female is 1.5 to 1 (American Psychiatric Association [DSM-IV-TR], 2000). This shown that mental retardation affect more male.

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The misconception about how people perceive what is mental retardation also being pointing out. According to a case study from World Health Organisation (2006), a special education teacher who teaches the disable children is advised by the family and also neighbours to resign from her work when she is pregnant after 12 years of marriage. The reason given is that they want her to avoid contact with these types of children (means disable), concerning her unborn child will be like them. Acknowledged that this is superstitions, and with the support from her husband, she continues to help the children at the centre, and now her new born daughter’s intelligence is above average. Mental retardation is not something such as you having green eyes, bad heart, or you are born short or thin, it is also not medical disorder, nor a mental disorder (The American Association on Mental Retardation, 2002).

Criteria Definition

Referring to the diagnostic and statistical manual of mental disorders fourth edition text revision (DSM-IV-TR), published by American Psychiatric Association, there are three components of feature of mental retardation, which all of the component must be present to diagnose a patient with mental retardation (American Psychiatric Association [DSM-IV-TR], 2000). The three diagnostic criteria for Mental Retardation are as below:

Criterion A. Significantly sub-average intellectual functioning: an IQ of approximately 70 or below on an individually administered IQ test (for infants, a clinical judgment of significantly sub-average intellectual functioning).

Criterion B. Concurrent deficits or impairments in present adaptive functioning (i .e., the person’s effectiveness in meeting the standards expected for his or her age by his or her cultural group) in at least two of the following areas: communication, self-care, home living, social / interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health, and safety.

Criterion C. The onset is before age 18 years.

In Criterion A, IQ or Intelligence quotient test had used to administer the general intellectual functioning of an individual. Intelligence is the general mental capability. It included the ability in reasoning, problem solving, abstract thinking, understanding complex ideas, quickly in learning, and also experience learning (American Association on Mental Retardation, 2002). The commonly IQ test such as the 3rd edition Wechsler Intelligence Scales for Children; 4th Edition Stanford-Binet; and also Kaufman Assessment battery for children. All of this is an individually administered intelligence test. The cut-off score is IQ test scored 70 or sub-average intellectual functioning is IQ score of about 70 or below, which are two standards deviation below the mean. However, in some cases, although the individual’s IQ score is below 70, he or she should not be diagnosed as mental retardation if there is no obvious disturbance in adaptive functioning. Adaptive functioning will be explained in Criterion B. The diagnostic and statistical manual of mental disorders fourth edition text revision (DSM-IV-TR) (2000), some others factor that may result an individual score poorly should be taken into consideration. For example, some of the factors include the socio-cultural background of an individual; the problem with native language; as well as related communicative, motor and sensory handicaps (American Psychiatric Association [DSM-IV-TR], 2000).

There is four degree of severity of mental retardation. The degree of severity is determined by the IQ scores. The summary of the retardation and IQ level are as below:

Mild mental retardation IQ level 50-55 to approximately 70

Moderate retardation IQ level 35-40 to 50-55

Several mental retardation IQ level 20-25 to 35-40

Profound mental retardation IQ level below 20 or 25

(American Psychiatric Association [DSM-IV-TR], 2000)

About 85% of the mental retardation patient is fall under Mild Mental Retardation, which their IQ level through IQ test is about 50-55 to approximately 70 (American Psychiatric Association [DSM-IV-TR], 2000). Normally, they can’t be differentiating with normal children at the age of 0-5 years old. This is because; the social and communication skills are developing at the age of pre-school (American Psychiatric Association [DSM-IV-TR], 2000). At this stage, they have minimal disturbance in sensor motors areas (American Psychiatric Association [DSM-IV-TR], 2000). The characteristic representing this category is the role of Forest in the movie Forest Gump. In the movie, Forest ever said that “I been an idiot since I was born. My IQ is near 70, which qualifies me, so they say. (Smith, 2006).” With the appropriate support, patient with mild mental retardation can live successfully. Forest, who always being classified as retarded used chocolate to contrasting portrait of his struggle until he become a football star in the college, Vietnam war hero, and a successful business man (Smith, 2006).

. On patients with moderate mental retardation, we usually refer them as “trainable” (American Psychiatric Association [DSM-IV-TR], 2000). About 10% of the mental retarded patients fall under this category (American Psychiatric Association [DSM-IV-TR], 2000). They learn communication skills at the early childhood, so that they can benefit from vocational training. With moderate supervision, patient with moderate mental retardation can actually fulfill personal care. They are able to travel by them self in a familiar setting; however they can’t progress beyond the 2nd grade level in the academic subject (American Psychiatric Association [DSM-IV-TR], 2000). In a supervised condition, patient can function well with the community around them.

For patient with severe mental retardation, they are actually 3-4% of the mental retardation population (American Psychiatric Association [DSM-IV-TR], 2000). During pre-school period, they might learn a little or no communication skills. During the school period, they learn talking at secondary level, they can be teaches in self-care. In a closely supervise condition, they can function well in life if they do not involve in any handicap.

Patient of mental retardation who falls under the profound mental retardation is 1-2% (American Psychiatric Association [DSM-IV-TR], 2000). Most of the patient has a neurological condition that result their mental retardation. Their motor development, self-care, and communication skills can be improve if there is a proper education being given to them.

If a mentally retarded patient who can’t be categories within this four degree of severity, they will be put under the category mental retardation, severity unspecified.

In Criterion B, impairment in adaptive functioning is the focus. Impairment functioning is the effectiveness of a person coping with daily life events and also how well a person achieve the standard of self independence expected by their age group in a particular socio cultural back ground as well as community setting (American Psychiatric Association [DSM-IV-TR], 2000). Yet, there are various factors that might influence the adaptive functioning of a person with mental retardation. Some of the factors are education, motivation, a person’s characteristic, social and vocational opportunities and the mental disorder and general medical conditions (American Psychiatric Association [DSM-IV-TR], 2000). The areas of adaptive functioning concerning is communication, self-care, home living, social social / interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health, and safety. A person can only be diagnose with mental retardation if he meet any 2 of the area concerning in criterion B. For example, at the age of 16 years old, a person could not speak and poorly performance in academic.

In criterion C, age is the focus. The onset must be before 18 years old.

Intervention Programme

Intervention programme are to believe will help the children with mental retardation to cope better in their daily life as well as future life. Intervention program for the mentally retarded children usually take part by the government, non-governmental organisation, school and also psychologist or expert in the field. Although it was take part by many organisations, but we have to aware that the intervention program cost a large sum of money. Medical news today (2006) reported as in years 2000, money spend for patients with mental disorder is about 51 billion dollars. However, the intervention program is still necessary to provide the patient another part of life.

One of the intervention programs for children with mental retarded is occupational therapy. In occupational therapy, thought about daily life functioning being discuss and share with the children (Kottorp, Hallgren, Bernspang, & Fisher, 2003). This therapy leads the children to perform the daily life task that the child would like to, or the task which is expected by the society or cultural back ground (Kottorp, Hallgren, Bernspang, & Fisher, 2003). The most important aims of occupational therapy are to lead the children to have meaningful and purposeful occupations through the intervention (Kottorp, Hallgren, Bernspang, & Fisher, 2003). Occupational therapy also focuses to help the child with mental retardation to develop fine motor control (Reynolds & Dombeck, 2006).This fine motor skills is needed by the children with mental retardation to perform concentrated tasks (Reynolds & Dombeck, 2006). Some of the concentrated tasks are like writing or drawing. All of this basic concentrated task is important for self-help and academic skills in the later life of the children (Reynolds & Dombeck, 2006). Researcher found that occupational intervention program had a positive feedback (Kottorp, Hallgren, Bernspang, & Fisher, 2003). Patient can carry out activities of daily living in a safe and efficient manner. (Kottorp, Hallgren, Bernspang, & Fisher, 2003). In summary, Occupational therapy intervention program for children with mental retardation, aims to help the children to meaningful and purposeful activity. The activity include self-care, care for others, appreciate life and socially active in various situation. Mental retarded children who went through this therapy will able to use the skills learned in future.

Another intervention program for children suggested by researcher is tooth-brushing intervention program. In a study done by Stefanovska, Nakova, Radojkova-nikolovska, & Ristoska (2010), they designed a 6 month intervention program that focus on the encouragement of independent manual skills looking after personal oral hygiene.100 school children at the age of 9-16 with low and moderate mental retardation in Skopje. Althought tooth brushing seems to be very easy for us, but it actually is a voluntary activity that requires motivation and physical ability. In term of motivation, the children with mental retardation are require to understand what is needed and also the reason or benefits of tooth brushing; and also the desire to achieve the benefit (reducing the plaque). Yet, they found that children with mentally retarded are not capable in understanding the oral hygiene procedures but they accept the change (Stefanovska, Nakova, Radojkova-nikolovska, & Ristoska 2010). According to the researcher, patient of mental retardation normally suffered from periodontal disease. The result of their study showed that this six month program was effective in reducing the plaque and gingivitis scores and the long term success of the program is to maintain the children’s motivation to brush their own teeth and make this part of their daily routine (Stefanovska, Nakova, Radojkova-nikolovska, & Ristoska 2010). Calculated the long term benefit, tooth brushing is actually cost effective ways of reducing plaque, reducing the needs to see dental doctor and others. The mentally retarded children are able to brush their own tooth with proper encouragement and motivation.

Besides that, Rezaiyan, Mohammadi & Fallah (2007) proposed that computer game as an intervention instrument focusing on the attention capacity of the mentally retarded children. In their experiment, 60 male mentally retarded children were recruited from two 24 hours care centers in Tehra. All of them had an IQ level between 50 and 70 with no physical disability. The result of their study indicated that intervention of computer games increased the attention span of the mentally retarded children (Rezaiyan, Mohammadi & Fallah, 2007). Not only that, intervention of computer game also help in increasing the internal motivation and activity if the children (Rezaiyan, Mohammadi & Fallah, 2007). The mentally retarded children was attracted by feature of the computer games such as competition, laugh, curiosity and others, and all of this helped in improving the ability to pay attention (Rezaiyan, Mohammadi & Fallah, 2007). The children also learned problem solving skills through the games Rezaiyan, Mohammadi & Fallah, 2007). In order to complete the game, the children need to practice and keep repeating the same process, this had help the children in self understanding skills, while paying attention to an object or location will improve the nervous system process (Rezaiyan, Mohammadi & Fallah, 2007). In summary, as we can see, the main function of the computer games is to help the children in understand and paying attention. The two benefits are actually interrelated to each others, to pay attention you need to understand, understanding help you in paying attention. The mentally retarded children need both of this skill. However, we should also consider the side effect of using computer.

Special education is another intervention program for the children with mental retardation. In Malaysia, a Non-governmental organisation, Lions Club of Kota Bharu operates a Down syndrome centre to give pre-school education to the Down syndrome children ages there to six years (Dahari, 2009). Down syndrome cause by the non-disjunction of chromosome 21and is the leading genetic cause of mental retardation (Ghosh, Sinha, Chatterjee & Nandagopal, 2009). After graduated from the canter, the Down syndrome children will be sending to the special classes in the government school. They adopt the Macquire Small step curriculum as teaching guide or you may called it as early intervention program. The term intervention is used to cover physiotherapy, occupational therapy, speech therapy and special education help. There are several type of intervention provided such as home based, centre based, and nursery based. Parents with Down syndrome children might send their children to this centre for early education. Mentally retarded children are educable (Demirel, 2010). Another intervention in term of education being done in Turkey, the curriculum for children with mental retardation was designed at primary school level, attending private class, focusing on improving the skills of understanding, showing positive social relations, adjusting to the social, technological and physical environment and surviving independently (Demirel, 2010). From two of this example, we can see that education actually help the mentally children to make their life better. As a psychologist, we should support all kind of effort in coming out with special education for the mentally retarded children. Education is one of the best intervention programs for the children.

In conclusion, no one is this world choose to be born mentally retarded; mentally retarded is a give but not a choice. As a normal human, we should not discriminate them yet give them the best of what we can do. Intervention program had being proven able to help the children with mental retardation to have a batter life. Every one of us should play our roles in supporting all kind of intervention program. As a psychologist, we actually can do many things for them as there are within our area of study, we can contribute idea regarding their well fare, education and in others issues. They had born unlucky, why not we shown them another part of life?