The etiology of mental sub normality often remains unknown even after detailed investigation, but a history of parental or post natal abnormalities may provide a probable explanation.
The practical importance of investigation has value in deciding genetically determined diseases, so that genetic advice may be given and the rare preventable or treatable conditions. A precise diagnosis may also have prognostic value.
Early detection of mental sub normality is important not only for the rare treatable conditions like cretinism, phenylketonuria and galactosemia, but for the others so that the parents may be given maximum help at a time when definitely they may need it most. It is the general opinions that only when the physician has the definite diagnosis of mental retardation in a child, must he impart this information to the parents.
This distasteful task requires time, tact, abundant sympathy and understanding but the situation must be explained in simple terms. In the case of a very young child the physician would be wise not to commit himself to firmly or to soon about disability or educability's. These matters will be resolved with time, and it is the physician’s duty to see the child and his parents regularly and to be prepared to give his time to answer their questions. In particular, feelings of guilt which many parents have on hearing that their child is mentally retarded must be changed by quiet discussion and explanation. Some parents will initially refuse to accept the situation and may go to other specialists seeking a happier diagnosis. This is completely understandable.
It is best for mentally subnormal children to be brought up in their own homes, since no one can replace the mother or give much individualized attention to the child as she can. Residential accommodation is recommended only for certain cases of the parents or sibs having special needs.
Level of severity of Mental Retardation:
i) Border line: Children whose IQ are between 68-83, vulnerable to educational problems Most achieve independent social and vocational adjustment.
ii) Mild: Children with IQ between 52-67 ,they are most need at least some special class placement. Some able to function independently as adults.
iii) Moderate : IQ between 36-51 may be able to function semi-independently in supervised living.
iv) Severe: IQ between 20-35 can learn minimal self care and simple conversational skills. Need much supervision throughout their lives.
v) Profound: IQ less than <20 must require total supervision. Very minimal self-care skills are possible. Language development is minimal.
Many parents are given the impression that they will be better off in a residential home because he will learn more quickly in expert hands; this is incorrect. Residential care may be recommended because the parents are suffering such emotional and physical strain that they decide to have no further children but when there is no heritable cause for the condition and when it is obvious that they are longing for another child. It may also be recommended if the siblings are suffering from lack of parental love and attention. Residential facilities are not available in many poor countries at present.
For most conditions parents of mentally subnormal children must be told that no specific treatment is available. However in saying this doctor must not suggest that nothing could be done to help. The parents require a great deal of advice on providing play facilities to stimulate the child's development. This approach, coupled with the attention to remove suffocating emotional reactions which can increase the retardation, will permit the child to develop to the utmost of his capabilities.
The mentally subnormal child has the mind of one much younger than himself. He should therefore be handled in a manner appropriate to his mental age rather than chronological age.
A check should be kept on weight gain since these children are over-weight, making their motor activity still more difficult. This excessive weight gain is related partly to lack of exercise and partly to overfeeding.
Educational needs will be determined after formal assessment and the determination of the intelligence quotient. The child with an IQ between 50 and 70 is usually educable at a special school. His progress there will depend not only upon his ability but on the support and training he receives. Many parents may do their utmost to prevent the child leaving an ordinary school.
Children whose IQ is less than 30 are ineducable, too retarded to be taught to read and write, thus should be placed in an occupational or training center.
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