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Mental retardation continued

Last week we looked at the impact of mental retardation on a person’s personality and the characteristics through the case of Prasad. A few interventions can be implemented for the mentally retarded adolescent. It has been found that the living conditions, job opportunities and leisure activities afforded to those with mental retardation have been clearly inadequate. In addition, developmentally disabled persons have rarely been given the opportunity to express preferences and make personal choices with regard to living, working and recreational activities. These factors also contribute significantly to the development and maintenance of behavioral disturbances. The concept of normalization is to make available to Prasad; all the patterns of life and conditions of everyday living that are as close as possible to the regular circumstances in society. This can lead to more mature and responsible patterns of behavior and improve the quality of life for Prasad. To effect positive change in the living situation, the optimal set of environmental and ecological circumstances must be identified. You have to make a systematic assessment of what are the antecedent and consequent circumstances associated with his mood changes and the negative and positive patterns of behavior that determine his adaptive and nonadaptive state. Once identified, the salient environmental factors can be altered to enhance his adaptive functioning. This process applies equally to the major factors in his life – home environment, study, daily schedule, household chores and so on. Modification of the stimulus set often can lead to significant behavioral change. That may involve increasing access to preferred activities, offering choices with regard to household tasks and scheduling highly preferred tasks and activities immediately following nonpreferred but necessary ones. Although many of these changes appear simple and obvious, they are often overlooked, perhaps because of such factors as pessimism regarding the possibility of behavioral change and demoralization. However, their identification can be the most important. Another factor is educational intervention and skill development. Emotional and behavioral disturbances often result from a lack of competence. The presence of communication deficits, a slow learning profile and limited educational opportunities often result in a lack of skills necessary for demonstrating personal competence and social responsibility. You have to implement an educational program of independence training (teaching self-help and leisure skills), communication training (enhancing speech and nonverbal communication with signing or gestures) and self-management skill development (self-monitoring and self-reinforcement). These will help to reduce maladaptive behavior. It also includes social skills training like making introductions and conversations, initiating and participating in social group activities and reading and appropriately responding to verbal and nonverbal social cues. There should be a combination of teaching and instruction, demonstration, modeling, role-play, practice, constructive feedback and positive reinforcement. The most widely used strategies include behavioral methods. The behavior enhancement procedures lead to a reduction of undesirable behaviors by promoting adaptive solutions to problems and frustrations. There is differential reinforcement i.e. Prasad should be rewarded for not exhibiting a certain behavior like throwing a tantrum in a public place. If the undesirable behavior does not occur in a specified time interval, reinforcement is offered. It should be long enough to require some effort but short enough to promote success. The other procedure is replacement of incompatible behavior with a preselected adaptive behavior – like calmly asking for food instead of a tantrum in a restaurant. The other methods are behavior reduction procedures involving the introduction of an unpleasant, punishing circumstance contingent on the occurrence of some behaviors. They include time out from play, no positive reinforcement, response cost – the loss of a previously earned reward, over correction – the restoration of a disrupted environment like replacing furniture and cleaning up everything. These techniques are efficacious in short-term. You need to be careful not to go on a punishment drive in order to teach problem-solving skills. The other important guideline is regarding special education for Prasad. The concept is for mainstreaming – full integration into a regular classroom with supplementary tutoring for special classes. He should have shared classes for physical education or lunchtime and separate for academic subjects. The academic progress depends more on the quality of educational strategy and the teacher’s training, experience and motivation. The other intervention is in the role of medicines for certain problems. Mentally retarded children are more prone to problems of attention and concentration, mood variations and rigidity of behavior. Medicinal support may help them to cope with the problems. The other issue that may face you in the near future is about his sexuality. When expressions of developmental sexual interest are prohibited or denied, there may be a need to demonstrate self-interest and to gain acceptance from others. Consequently, you may need to encourage relationships with others and teach appropriate social skills in regard to sexual and gender-specific behavior. There has been the exploration of the benefits of institutional care for mentally retarded people and establishments of residential institutes also. However, it has been found that for people like Prasad, who have been diagnosed with mental retardation much later after birth, institutional care is difficult, as the emotional attachment to the family has occurred. A return to the community is hampered and the difficulties are in the areas of self-care, language, learning, mobility, self-direction, independent living and economic sufficiency. If these areas are taken care of in the society itself, the need to put in an institution also decreases. The sibling rivalry and emotional outbursts can be controlled through the behavior modification techniques. It is indeed a challenging task to take care of a mentally retarded child and I hope these guidelines are able to help you chart the course of your actions for your child.

 

Dr. Darshan Shah

Dr. Darshan Shah, a renowned psychiatrist and psychotherapist, is committed to make a difference in the area of mental health and help individuals cope with feelings and symptoms; change behavior patterns that may contribute to one’s illness and henceforth contribute to their newly improved pathway of life.

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