MENTAL RETARDATION (PREVENTION, CARE, AND TREATMENT)

Considerable progress has been made in the care and treatment of the mentally retarded in recent years. In the past the major emphasis was on custodial care in large institutions; today it is on a comprehensive approach that includes medical treatment, parent education, special classes in schools, vocational training, sheltered workshops, and, where institutionalization is necessary, small residential centers within the community. The combined effect of these approaches has been to demonstrate that far more retarded people can be helped to lead happy, productive lives than was thought possible a generation ago.Many of the most promising developments have been in the medical field. In all cases early diagnosis and prompt treatment are essential to prevent brain damage where this is possible, since it is irreversible once it has occurred. Regular administration of thyroxin is remarkably effective with hypothyroidism (cretinism), and as a result very few of these cases are confined to hospitals today. Recently developed surgical techniques have arrested many cases of hydrocephaly. Surgery has also proved helpful in many cases of retardation associated with brain tumors and craniostenosis. Special diets are frequently successful with phenylketonuria (PKU) and galactosemia, and seem to be promising in treating maple sugar urine disease. Bilirubin encephalopathy (kemic- terus) can sometimes be forestalled by blood transfusions. Congenital syphilis usually responds to penicillin, and epidemic meningitis to the sulfa drugs. See these topics.Medical treatment in the form of tranquilizing drugs can also be applied to the minority of mentally retarded children who develop hyperactive, destructive, or withdrawn behavior. Chloro- promazine has been found effective in controlling disturbed behavior in about two-thirds of cases, although individual reactions vary widely. Drugs do not improve the basic intelligence of these children, but in some cases help them to develop their potential more fully and to function more effectively.The use of psychotherapy with retarded persons dates from the middle 1950s, since before that time it was assumed that average or above average mental ability was essential to this form of treatment. In support of this view a number of studies appeared to indicate that the higher the intelligence, the better the chances for successful psychological treatment. However, in recent years a number of psychologists and psychiatrists have made systematic attempts to utilize psychotherapy with the retarded, particularly on a group basis, and this form of treatment has proved effective in many instances. As a result, group psychotherapy is now a widely accepted treatment technique for selected cases of mental retardation. Again, it does not increase intellectual ability, but it may help the individual accept his limitations and achieve a better social, emotional, and vocational adjustment. See ART THERAPYThe problem of education and training for the mentally retarded begins with the task of identification and diagnosis. Only children with fairly gross defects are likely to be diagnosed in infancy; others are not identified until the pre-school years when a developmental mental lag begins to be apparent; still others are not discovered until they have had several years of schooling. Adequate diagnosis requires not onlv an intelligence test but an over-all medical,educational, and social evaluation. Great care must be exercised to distinguish mental retardation from other conditions such as simple schizophrenia, cerebral palsy, and perceptual disorders. Today a number of institutions operate pre-admission or outpatient clinics for diagnosis, and in addition there are traveling clinical teams as well as approximately 100 full-time clinics, usually associated with hospitals, health departments, medical schools, and community centers.One of the major objects of diagnosis is to determine the degree to which the retarded child is academically ed- ucable, or, if not educable, trainable. The child is usually considered educable if his rate of intellectual development is from one half to three quarters of what is expected of a normal child of the same age, and if he can be expected to reach fourth- or fifth-grade achievement in academic subjects (with or without special education), even though he is incapable of mastering formal reading until he has reached nine to twelve years of age. He must also be able to communicate adequately in normal situations, handle the usual demands of social and personal give and take, and in most cases develop occupational skills that will lead to economic independence later in life. See mental retardation (types).Although facilities for education and training are far from adequate today, many promising types of schools have been developed. On the pre-school level, there are special day-care centers which offer stimulating activities and special training. These centers not only enhance the children’s development, but also relieve the parents of the burden of caring for them, so that the mother may spend more time with her other children, and take a job if necessary. On the elementary level, children may be transported to special schools for the retarded or, more often, attend special classes in regular schools. In larger school systems these classes may be homogeneous—that is, made up of children close in chronological and mental age; in smaller systems they are usually heterogeneous, covering a wide chronological and intellectual range. See nursery school experience.On the secondary level the young person may in some cases spend part of each day in a special class with an adjusted program and part in regular classes devoted to physical education, arts and crafts, industrial arts, home economics, music, and other activity subjects. In other cases, the retarded are placed in a slow section of regular classes where they are given individual attention.A few large cities have special occupational high schools for apprenticeship training and preparation for relatively unskilled jobs. About forty states have instituted special classes for training the mentally retarded, but at present there is a shortage of teachers and facilities. The fact that training can be highly effective has been strikingly demonstrated in a New York City study cited by Kisker (1964), in which children with IQs between 40 and 50 attended classes. The results show that only 26 per cent were subsequently institutionalized, 27 per cent of those residing in the community were working for pay at the time of the study, and another 9 per cent had worked for pay at one time or another. (Saenger, 1957)Another important approach,' the sheltered workshop, has proved highly successful for both the educable and the trainable. The work is performed for actual companies, under subcontract, and usually consists of repetitive hand or machine operations such as packaging, stapling, and punching carried out in a controlled environment under the supervision of specially trained individuals. The educable retarded usually travel to and from work on their own at times that avoid the rush hours. Many of them develop their work skills to a point where they can take regular jobs in the outside world. The trainable group, on the other hand, continue to work under supervision and are rarely capable of outside employment.The Federal Office of Vocational Rehabilitation makes grants to states for work projects, vocational training centers, and counseling for the mentally retarded who are capable of following a vocation. In addition, home training and counseling are now offered to their parents by many public and private agencies. They receive instruction and guidance on meeting the physical, emotional, and social needs of these children, and on the special problems that are bound to arise as they grow older. Through counseling, they are given an understanding of the child’s present status and future possibilities, the nature of the diagnosis, and the need for long- range planning for education and training, or for institutionalization where necessary. One of the most important aspects of the counseling process is emotional support for the parents, to help them accept the retarded child and themselves as well.Today it is widely recognized that significant progress in the field of mental retardation can be made only through organized research and the application of new knowledge on a broad social basis. The White House Conference of 1960 advocated a broad approach to the problem, aimed at (1) stimulating basic research in the field of genetics and genetics counseling as a means of preventing the hereditary forms of mental retardation; (2) initiating programs for the early diagnosis and treatment of such conditions as phenylketonuria, hypothyroidism, and blood-factor incompatibilities through public health services and hospitals; and(3) focusing special attention on the care and treatment of mentally retarded children in deprived groups, including the prevention of mental retardation caused by impoverished environments, and improvement in economic, social, educational, and nutritional conditions.The White House Conference advocated research not only on the medical aspects of mental retardation, but on the social, behavioral, and educational aspects as well, including the nature of the intellectual skills required for independent functioning in different sectors of society, individual differences in ability among the mentally retarded beyond the unitary IQ index, development of guidelines for grouping children educationally according to their learning characteristics, assessment of the cumulative effects of continuous programs aimed at mental, social, intellectual, and vocational development of the mentally retarded, and ways of modifying the unfavorable stereotype of the mentally retarded prevalent among public and professional groups.The greatest stimulus to research has been the availability of Federal funds through the National Institute of Mental Health, the National Institute of Neurological Diseases and Blindness, and other governmental agencies. Substantial grants are being made to hospitals, medical schools, universities, and private laboratories throughout the country as part of a total Health, Education, and Welfare expenditure for the mentally retarded, which rose from1. 7 million dollars in 1950 to 26 million in 1961, about 11 million of which was devoted to research. There has been a corresponding increase in the research projects supported by private agencies such as the Ford Foundation and the Joseph Kennedy, Jr., Foundation. But in spite of these promising developments,

Cite this page: N., Pam M.S., "MENTAL RETARDATION (PREVENTION, CARE, AND TREATMENT)," in PsychologyDictionary.org, November 28, 2018, https://psychologydictionary.org/mental-retardation-prevention-care-and-treatment/ (accessed January 16, 2021).
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