Mental retardation - issues to address

Upul Ranjit FERNANDO

Mental retardation in a child can be due to pre-natal malformations in neurons (cells) in the brain due to genetic or other causes or can occur at birth on unusual pressure exerted on the cranium at delivery, damaging the early neural structure of the brain.

This condition is manifested when the new-born does not display in time to come, the normal abilities in speech, movement, in getting up on its feet, which are the symptoms that indicate a neural disorder.

Subsequently, parents realize at various stages of growth of the child that the child has learning disabilities, conduct disorder, speech problems, autism, epilepsy or seizures, and problems relating to hearing and vision.

At a recent symposium organized by the Sri Lanka College of Pediatricians under its President, Professor Asvini Fernando, in collaboration with the World Health Organization, it was revealed by Professor Hemamali Perera, Consultant Child Psychiatrist, that a local survey had revealed that 1 in 93 children born, display Austism Spectrum Disorder (ASD). A nation-wide study done by researchers in the University of California, Los Angeles, revealed that the children from low-income families were about 40 percent more likely to be diagnosed with the condition known as Attention Deficit Hyperactive Disorder (ADHD).

Autism

The main, displayed features of Autism are:

(a) Lack of social interaction

(b) Lack of communication

(c) Repetitive Behaviour

(d) Repeating the same words and sentences

(e) Avoiding eye contact

Attention Deficit Hyperactive Disorder (ADHD)

At a lecture given by Dr Sunera Fernando, Consultant Psychiatrist, at the National Council for Mental Health (Sahanaya) she outlined the main features of the disorder (The child may display a few of these):-

* difficulty in paying attention

* inattention to details and makes careless mistakes

* easily distracted

* Loses school supplies, forgets to turn in home-work

* difficulty in finishing home-work/class work

* difficulty in listening

* difficulty to follow multiple adult's commands

* impatience

* fidgets and squirms

* leaves seat and runs about or climbs excessively

* seems always ‘on the go’

* talks too much and has difficulty in playing quietly

* interrupts and intrudes on others

Learning disorders

Dr Sunera Fernando in her lecture, identified the following:

Parents should be aware of the most frequent signals of learning disabilities, when a child -

* has difficulty understanding and following instructions

* has trouble remembering what someone has just told him/her

* fails to master reading, spelling, writing, math skills, and fails school work

* has difficulty in distinguishing right from left, difficulty in identifying words or a tendency to reverse letters, words or numbers (for example confusing 25 with 52, 'b' with 'd', or 'on' with 'no')

* lack co-ordination in walking, sports, or small activities such as holding a pencil or tieing a shoe lace.

* easily loses or misplaces home-work, school books, or other items

* cannot understand the concept of time, is confused by 'yesterday' 'today' or 'tomorrow'.

Epilepsy

Epilepsy could occur in small babies and is commonly called 'a Fit'. This happens due to some deviation in the rhythm of spasms in the brain, due to a neural disorder. This can be immediately detected by obtaining an E E G (Electro-Encephalo-Graph). The condition of these children can deteriorate due to any mental stress, denial of affection due to separation from mother, beatings etc, which could lead to two situations of psychotic (serious mental illness) or neurotic (forms of behavioural problems) disorders.

Most children who have had epileptic fits display behavioural problems. This is due to their distorted perceptions in regard to happenings in the environment. When the child does not receive the expected tenderness, love and care, there is a tendency for aggressive behaviour which might develop progressively to commit violent acts. All this is part of the illness and the care-givers whoever they are, will have to handle these children on expert medical advice given by Neurologists, Psychiatrists, and Psychologists. As the child grows up psycho-therapy is essential to be imparted by qualified counselors, towards correction of any abnormal behaviour.

Lack of awareness by parents

Most of these children are exposed to verbal, physical and sexual abuse, or ridicule by others due to unawareness of the real causes of such behaviour, and therefore the care–givers should fully protect such children all the time.

This information has been made available by Dr Periannan Pillai - Psychologist, Dr Sunitha Galappathi - Psychiatrist, Dr Oosha Gunawardena - Psychiatrist, Dr Manoj Kumar - Psychiatrist, through lectures at the National Council for Mental Health (Sahanaya).

Thousands of mentally retarded children and adolescents as well as these persons who grow into adulthood undergo untold misery due to wrong handling of these 'patients', by parents and/or care-givers due to ignorance of the above-mentioned basic facts.

The national newspapers have reported many incidents of such children being chained to beds or posts and isolated and maltreated in various ways by verbal and physical abuse by parents or care-givers, and sexual abuse by outsiders and coercion of females into prostitution exploiting their helplessness. All these will aggravate their condition.

The universal opinion expressed by all expert medical personnel is that these affected children could be transformed into peaceful, productive and even brilliant activists in the fields of aesthetics like, performing arts, music, art and even other vocations, through proper methods of therapy including medication and behavioural therapy. Techniques have been developed and identified to improve and advance the abilities of these children, adolescents and adults.

These methods are technically identified as Cognitive Behavioral Therapy (CBT), Psychological counseling, Occupational Therapy, etc, which should be accompanied by medication.

There has to be adequate counselling for parents too for them to understand and then accept the reality of the child's affliction and start appropriate early interventions as advised by the relevant medical experts.

Sadly, there are no state institutions which have residential development and training facilities to care for the children of low and middle-income groups. Certain private institutions charge exorbitant fees for such facilities.

There is a Cabinet-sub Committee appointed by President Mahinda Rajapaksa to draw up a National Action Plan to Combat Autism and this sub-committee should also focus on the plight of the mentally retarded - both under and over 18 years. At present there are no state institutions catering for the over 18 years category who need in-house systematic training to make them productive and make them free of danger of molestation etc. and mental distress.

With the growing phenomenon of the mentally retarded children, these matters should engage the attention of both the government and the general public.

The writer is a certificate holder in Counselling and Mental Health, National Council for Mental Health (Sahanaya)