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The World Health Organization (WHO) of the United Nations Organization (UNO) in the International Statistical Classification of Disease and Related Health Problems defines Mental Retardation as
A condition of arrested or incomplete development of mind, which is especially
characterized by impairment of skills manifested during the developmental period,
skills which contribute to the overall level of intelligence i.e., cognitive language,
motor and social abilities. Retardation can occur with or without any mental and
physical condition. (ICD-10, 1992, p176)
This condition is also referred as Intellectual Disability or Developmental Disability. In India “Mental Retardation means a condition of arrested or incomplete development of mind of a person which is specially characterized by subnormality of intelligence” (Persons with Disabilities Act, 1995, p 5).
Intelligence is a general mental capability. It includes reasoning, planning, solving problems, thinking abstractly, comprehending complex ideas, learning quickly, and learning from experience. Limitations in intelligence should be considered in the light of four other dimensions; Participation, Interactions, and Social Roles; Health; and context Adaptive Behaviour.
Intelligence in conjunction with adaptive behaviour helps in categorization of the degree of Mental Retardation which is conventionally estimated by standardized intelligence tests and supplemented by scales assessing social adaptation in a given environment. It provides a more comprehensive understanding of how a child is able to function within his/her environment. Assessments of adaptive behavior typically focus on domains such as communication, self – care skill, and interpersonal relationships. Further, these change overtime, and, however poor may improve as a result of training and rehabilitation.
By these measures an approximate indication of the degree of mental retardation can be diagnosed viz., Mild Mental Retardation approximate IQ range of 50 to 69 (in adults, mental age from 9 to under12 years); Moderate Mental Retardation approximate IQ range of 35 to 49 (in adults, mental age from 6 to under 9 years); Severe Mental Retardation approximate IQ range of 20 to 34 (in adults, mental age form 3 to under 6 years). Profound Mental Retardation IQ under 20 (in adults, mental age is below 3 years). (ICD-10, 1992)
Behaviour involves action which is observable, measurable in terms of motor, cognitive and emotion (Peswaria and Venkatesan, 1992). Some of the behaviour is directly observable, while some are not directly observable as they are abstract and can only be interpreted. For example, happy cannot be seen directly, but it could be interpreted through behaviour, such as smile, laugh, etc. Some of our behaviour is directly measurable can be directly counted or numbered then it is measurable, while some are not directly measurable.
Behaviour is seldom function of only one stimulus. But, it is a function of many stimuli converging upon the organism at any given time. These many stimuli and their related traces interact with one another and their synthesis determines behaviour. All the socially accepted behaviour has the cognitive, motor and emotional component, which help to lead a better adaptive behaviour.
Adaptive behaviour has become and increasing important concept in the assessment and treatment of individuals with cognitive disabilities. In simple words adaptation means change over time to improve fitness or accuracy. It dependent upon both developmental status and cultural expectations e.g. assess performance in school, the ability to care for once self at home, interacting with peers and adults, and levels of independence in a variety of settings.
It draws together a person’s cognitive and personality characteristics. This is the collection of conceptual, social and practical skills that have been learned by people in order to function in their everyday lives. It can be understood as the functioning of an individual in his or her environment.
It involves socialization process by establishing satisfactory relationship with other people and conforming to the cultural standards. It also involves learning that other people are necessary and becoming dependent on them. Almost as soon as this awareness develops, however, infants must begin to move in the direction of establishing independence. Social immaturity in adults is both a societal problem and also a personal problem for affected individuals, their families, and their employers. Social immaturity either plays an important role in maintaining multiple mental disorders or is in fact what defines those disorders. This is particularly true of the ‘dramatic-erratic’ personality disorders, including Narcissism, Borderline, Histrionic and probably also Antisocial Personality Disorders. Social immaturity is also quite frequently associated with long term alcoholism and/or drug abuse which began in youth, and is frequently encountered by therapists treating clients who have been abused as children. In short, Adaptive behaviour is the process through which the new born child is molded in to cultureâ€¦ and hence become an acceptable person in the society (AAMR, 2002).
In addition, we have observed most of parents having child with mental retardation have came across such incidences in their life facing some or the other difficulties due to the adaptive behaviour of their children. Whenever, these difficulties either solved or not resoluted, people around us start pulling our legs. We can react differently to these situations depending on our individual differences. One can get aggressive and start abusing or other can gently smile and accept the incident and reply accordingly for e.g. walking on the road you met a stranger who is very young and humble gentleman in his conversation, gets comments that you are old man. In these situations this gentleman should start using abusive language but he smiles gently and replies “Thank you! For calling me an old man, because this contains the wisdom of Life.” It reveals his high Self Esteem. Self esteem is a personal judgment of worthiness expressed in the attitudes of a person holds toward the self. When it comes to the parents having children with mental retardation most of them are depressed due their child condition, without accepting the fact that their child is special.
Self esteem is considered to be the central aspect of psychological functioning (Taylor and Brown, 1998; Wylie, 1979; Crocker and Major, 1989). It reflects a person’s overall evaluation or appraisal of his or her own worth. This encompasses beliefs and emotions such as triumph, despair, pride and shame. A person’s self-esteem is revealed in their behavior, through assertiveness, shyness, confidence or caution. It is distinct from self-confidence and self-efficacy, which involve beliefs about ability and future performance.
Rosenberg (1960) and social-learning theorists defines self-esteem in terms of a stable sense of personal worth or worthiness; this became the most frequently used definition for research, but involves problems of boundary-definition, making self-esteem indistinguishable from such things as narcissism or simple bragging.
Self esteem is strongly related to many other variables (Diener, 1984; Crocker and Major, 1989). Behaviour and self esteem are closely linked. Better adaptive behaviour leads to better self esteem (Crocker and Major, 1989). If any deficit in the adaptive behaviour which ruptures the self esteem influences the quality of life, self image, body image due to which an individual goes into feeling of negativity. Dependency on others leads to depression, behaviour problem and antisocial behaviour hence affecting the Self Esteem.
REVIEW OF LITERATURE
Zigman, Schupf, Urv, Zigman and Silverman (2002) have discovered significant decline in adults with Down syndrome increased from less than .04 at age 50 to .67 by age 72, and in adults with mental retardation without Down syndrome increased from less than .02 at age 50 to .52 at age 88. Moreover, adults experience overall decline in behaviors which were identified based upon the sequence and magnitude of changes, suggesting a pattern of loss not unlike that is noted in the population without mental retardation with dementia.
Fidler, Hepburn and Rogers (2006) explained similar patterns in kids and adult with down syndrome on relative strength and weakness which includes stronger social skills, weaker expressive language, and poor motor coordination. Socialization strengths differentiated the Down syndrome group from the mixed developmental disabilities group.
Prasher and Haque (1998) have examined the underlying factors for age-related decline in adaptive behavior for over a period of 3 year and the presence of dementia was the only determining factor, but difference in trend over time as compared to subjects without dementia was not significant. There no association was found between gender, sensory loss, severity of mental retardation, or place of residence and also no decline was seen between the subjects not having any significant physical or psychological disorder.
Mervis, Tasman, Mastin (2001) have revealed that the domains of socialization and communication are correlated highly whereas daily living skills and motor skills are relatively weak. Further, it was found that socialization skills was more advanced than communication skills, and that within the socialization domain, interpersonal skills is stronger than play/leisure or coping skills. Adaptive behavior standard score was not related to chronological age.
Hatton et al. (2003) have revealed that adaptive behavior skills increased steadily and gradually over time among children with less autistic behavior and higher percentages of FMPR expression showed better performance on all areas of adaptive behavior. Children without autistic behavior displayed higher scores and rates of growth on the Daily Living Skills domain, with the lowest scores in Socialization.
Campbell, Adams and Dobson (1984) studied a non clinical group of families and concluded that in families where there were low levels of independence and high levels of emotional connectedness, young adults tended to readily adopt family values with little exploration in career and relationships decisions, they referred to these phenomena as “identity foreclosure” or “premature commitments”.
Barber and Eccles (1992) explored that there is small differences between children in divorced and intact families in cognitive performance, delinquency and self-esteem, these differences frequently disappear when confounding and mediating variables are controlled. Further, they explained that family interaction impact on identity consolidation which is linked to educational, occupational goals and gender role related behaviors associated with marriage, family and job plans. In addition, possible benefits as well as potential costs of living with a single mother are influenced by maternal employment, family process differences, parental attitudes and expectations.
THE PRESENT STUDY
Age appropriate developed child increasingly becomes independent as they grow older acquiring the self-help skills through a combination of imitativeness and iron willed determination to be independent. For the handicapped child however, the acquisition of these skills may not be so easy; without special teaching he may remain dependent on help from others at almost every moment of an ordinary day. A child with better adaptive skills makes the child lives independently and their parents to be in high self esteem state.
The significance of the study will emphasize the need to raise our eyebrows and call for concrete steps to improve their self Esteem and help them to alienate their feeling of negativity and helplessness. This would help them to make efforts for the betterment of their life. Participation in such efforts of both governmental and non-governmental agencies at macro and micro level is essential.
In addition, researcher had observed based on the review of literature availability of research on adaptive behaviour and self esteem documented in the literature in western context. But, hardly able to discover any study related to the adative behaviour and self esteem in Indian context, which proposes the gap needed to fill. The investigator came up with the research problem to study the relationship of adaptive behaviour of Children with Mental Retardation and Self esteem of their Parents.
To study relationship of adaptive behaviour of Children with Mental Retardation and Self esteem of their parents.
To study differences in self esteem among the parent with respect to their gender.
To study effect of child’s level of retardation on self esteem of their parents.
To study effect of child gender on self esteem of their parents.
There will be no significant relationship between adaptive behaviour of Children with Mental Retardation and Self esteem of their parents.
There will be no significant difference in self esteem of the parent with respect to their Gender.
There will be no significant effect of child’s level of retardation on self esteem of their parents.
There will be no significant effect of child gender on self esteem of their parents.
It will include all the children with mental retardation and their Parents who are coming to visit autonomous government institutes, non government organizations working in the field of disability rehabilitation. The elements considered for the sample will include individual diagnosed as mental retardation and assessed on standardized Intelligence test by self or by an expert working in the field of disability rehabilitation and their Parents having high or low self esteem. The size of the sample comprises of 200 children with Mental Retardation and their Parents with high or low self esteem. Age range of children with mental retardation will be between 6 to 18 years. In addition, student below 6 years and above 18years associated psychiatric or medical conditions and persons with learning disabilities, cerebral palsy and locomotor disability will be excluded from the study. The study will use multi-mixed method and it will be cross-sectional in nature where it primary aims is to see the effect and establish relationship between variables. Multiple methods help to give complete analysis of the research as almost all the aspects can be covered through it (Silverman, 2000). Non-Probability Judgemental sampling technique will be employed.
Ethical issues regarding the data collection and participation of the subject will be considered. Data will be collected from the children with mental retardation and their parents using adaptive behaviour scale and self esteem inventory respectively. The data from the sample will be collected in two phase. Phase -I – the children will be assessed for their Retardation, Adaptive Behaviour and Level of Retardation or already diagnosed by an expert will be assessed on adaptive behaviour and their parents will be employed on the Self esteem Inventory. Phase -II – parent of children with mental retardation having no self esteem or not responded to the questions will be eliminated from the study, only with high or low self esteem will be included in the study.
Developmental Screening Test (DST). This was adopted by Dr. Bharat Raj (1977) form Denver Developmental Screening Test (1969), at All India Institute of Speech and Hearing (AIISH), Mysore. It measures mental development from birth to 15 years. It is a dependable assessment without requiring the use of performance Test. Appraisal is done by a semi structured interview with the child and parent or a person well acquainted with the child. It has 88 items distributed according to the age scale viz. 3, 6, 9, 1year 6 month, 2 year to 13 year and finally 15 year. At early stage motor behaviour items are kept. It signifies neurological and integrative behavioural implication which constitutes the natural starting point for development itself. Items of Adaptive Behaviour represent sensory-motor adjustment to object, person and situation.
Binet- Kamet Test of Intelligence (BKT). This is adopted by Kamet (1934) from Stanford-Binet Scale of Intelligence. Burt (1939) comments that Binet scale is more efficient for the diagnosis of mental retardation more than any other test of intelligence. Its correlation co-efficient is higher than 0.7 and validity was found by comparing the IQ as measured by this test with estimated IQ by the teacher is 0.5.
It is an age scale which extends from 3 years to 22 years as follows- 3 years to 10 years then 12 years, 14 years, 16 years, 19 years and 22 years. It measures ability that increase with age during childhood and adolescence. The test consists of 14 set for different age with 6 items and alternatives ranging between 1to 3. The test is administered individually to each subject. It measures the factors viz., Vocabulary, memory, imagery, reasoning, practical judgments, sensation, comprehension, perception of form, similarities, comparisons, and identical judgments (Madhavan, Kalyan, Naidu, Peshwaria and Narayan, 1989)
Vineland Social Maturity Scale (VSMS). It is adopted from Doll (1935) by A. J. Malin for measuring adaptive behaviour of children between 1yr -15 yrs for Indian population. Scale consists of 89 items spread in the age range of 0-15 year. It has 8 domains and assesses the child’s adaptive behaviour. The administration is carried out in the semi structured informal atmosphere.
Experiments have shown a consistent and high correlation between VSMS Social Age (SA) and a Binet Mental Age. Doll (1935) reported a correlation of .96 on a sample of normal children. The subscale is: -Self-Help General, Self-Help Eating, Self- Help Dressing, Self Direction, Occupation, Communication, Locomotion, and Socialization.
Self Esteem Inventory (SEI). Developed by Coopersmith (1986), is designed to measure evaluative attitudes toward the self in social, family and personal areas of experience. It has three forms viz., adult form, School Short Form and School Form. It consists of 58 items: 50 self esteem items and 8 items constitute the Lie Scale. The self-esteem items yield a total score and if desired, separate scores subscales – General Self, Social Self etc. The subscales allow for variances in perceptions of self-esteem in different areas of experience. The present study uses the adult form.
Data analysis will be carried out by using SPSS software16 version. The self esteem inventory will be standardized to use in Indian context, through various methods such as item to item total correlation will be applied to check the internal consistency of the questionnaires. Reliability test will apply to measure the reliability of the questionnaires. The relationship of adaptive behaviour of children with mental retardation and self esteem of their parents will be measured by correlation, single linear Regression. The comparison of self esteem among male and female will be measured through t- Test. Differences with respect to level of retardation will be measured through ANOVA.
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